Prague Med. Rep. 2020, 121, 42-48

https://doi.org/10.14712/23362936.2020.4

Acute Massive Pulmonary Embolism with Direct Visualization of a Free-floating Right Heart Thrombus Successfully Treated with Fibrinolysis: A Case Report

Elisavet Kaitalidou1, Dimitrios Karapiperis2, Vasileios Makrakis3, Maria Kipourou4, Dimitrios Petroglou5

1Department of Internal Medicine, 424 General Military Hospital, Thessaloniki, Greece
2Department of Infectious Diseases, 424 General Military Hospital, Thessaloniki, Greece
3Intensive Care Unit, 424 General Military Hospital, Thessaloniki, Greece
4Department of Pulmonology, 424 General Military Hospital, Thessaloniki, Greece
5Coronary Care Unit, Department of Cardiology, 424 General Military Hospital, Thessaloniki, Greece

Received February 7, 2019
Accepted February 17, 2020

A male patient with a history of immobilization due to motor weakness, was transferred to our emergency department after syncope during physiotherapy, with recorded hypotension. Transthoracic echocardiography showed severe dilatation of the right ventricle (RV), with apex hypercontractility and almost akinetic RV free wall. The above findings, in addition to the unexpected visualization of a large, free-floating, right atrial thrombus, a rare finding associated with high mortality, readily confirmed the clinical suspicion of acute pulmonary embolism (PE) causing circulatory collapse. Intravenous fibrinolysis and vasopressor therapy were successfully administered, and hemodynamic instability was soon alleviated.

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