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The Right Atrial Thrombus: The Sword of Damocles With Real Risk of Massive Pulmonary Embolism

Intensive Care Unit, Clinical Hospital Dubrava, Zagreb, mkirin{at}kbd.hr

Reuf Ceri, MD

Intensive Care Unit, Clinical Hospital Dubrava, Zagreb

Marko poljari, MD

Intensive Care Unit, Clinical Hospital Dubrava, Zagreb

Mario Pehar, MD

Intensive Care Unit, Clinical Hospital Dubrava, Zagreb

Gordana Cavri, MD

Intensive Care Unit, Clinical Hospital Dubrava, Zagreb

Ivana Rajan poljari, MD

Intensive Care Unit, Clinical Hospital Dubrava, Zagreb

Ivan Kirin, MD

Department of Surgery, University Hospital Rijeka, Rijeka Croatia

Cases of 6 patients admitted at the intensive care unit for massive pulmonary embolism are reported. All patients presented with dyspnea, tachypnea, and tachycardia, and 4 were hypotensive and had syncope. Lung ventilation/ perfusion scans revealed perfusion defects in 4 patients. Transthoracic echocardiography (TTE) demonstrated acute cor pulmonale. It also revealed mobile right atrial thrombi in 5 patients, adherent thrombus in the right atrium in 1 patient and patent foramen ovale in 4 patients. Thrombolytic therapy was initiated in 4 patients, and 2 patients received heparin infusion only. Effects of thrombolysis were monitored using bedside TTE during the first 24 hours and in follow-up. The outcome of 4 patients who received thrombolytic therapy was good whereas other 2 patients, who received only heparin, died. Thrombotic mass disappeared 8 to 12 hours after initiation of therapy, and 10 weeks after discharge TTE showed normalized right ventricle dimensions and function in all 4 patients.

Key Words: thrombolytic therapy • massive pulmonary embolism • right atrial thrombus

This version was published on August 1, 2008

Angiology, Vol. 59, No. 4, 415-420 (2008)
DOI: 10.1177/0003319707306218


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