Right heart thrombus in a patient with acute pulmonary embolism - a practice in hide-and-seek with guidelines
Introduction. Right heart thrombus (RHT) is a relatively rare phenomenon found in 4% of patients with acute pulmonary embolism (PE), and some reports show that the presence of RHT is associated with poor outcomes. The optimal treatment of patients with PE and RHT is still controversial, with no clea...
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Ministry of Defence of the Republic of Serbia, University of Defence, Belgrade
2023-01-01
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| Series: | Vojnosanitetski Pregled |
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| Online Access: | https://doiserbia.nb.rs/img/doi/0042-8450/2023/0042-84502200066R.pdf |
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| author | Ružičić Dušan Vuković Mira |
| author_facet | Ružičić Dušan Vuković Mira |
| author_sort | Ružičić Dušan |
| collection | DOAJ |
| description | Introduction. Right heart thrombus (RHT) is a relatively rare phenomenon found in 4% of patients with acute pulmonary embolism (PE), and some reports show that the presence of RHT is associated with poor outcomes. The optimal treatment of patients with PE and RHT is still controversial, with no clear consensus. Case report. A 38-year-old woman with repeated chest pain and worsening dyspnea was admitted to the hospital. The echocardiographical exam showed a large thrombus floating in the right atrium, protruding through the tricuspid valve into the right ventricle. Massive bilateral pulmonary embolism was confirmed by computed tomography pulmonary angiogram. Bearing these findings in mind and due to the clinical and hemodynamic instability of the patient, thrombolytic therapy was immediately initiated (alteplase), which resulted in excellent clinical outcomes with no adverse events at follow-up. Conclusion. Treating patients with PE and RHT is very difficult. While waiting for the results of some future randomized clinical trials on this topic, the treatment of these patients should be based on current guidelines while also considering the patient’s hemodynamic stability. |
| format | Article |
| id | doaj-art-e8292a85486049b5a1e7ceada641e935 |
| institution | OA Journals |
| issn | 0042-8450 2406-0720 |
| language | English |
| publishDate | 2023-01-01 |
| publisher | Ministry of Defence of the Republic of Serbia, University of Defence, Belgrade |
| record_format | Article |
| series | Vojnosanitetski Pregled |
| spelling | doaj-art-e8292a85486049b5a1e7ceada641e9352025-08-20T02:21:39ZengMinistry of Defence of the Republic of Serbia, University of Defence, BelgradeVojnosanitetski Pregled0042-84502406-07202023-01-0180545045310.2298/VSP190721066R0042-84502200066RRight heart thrombus in a patient with acute pulmonary embolism - a practice in hide-and-seek with guidelinesRužičić Dušan0Vuković Mira1https://orcid.org/0000-0002-3662-5374General Hospital Valjevo, Department of Invasive Cardiology, Valjevo, SerbiaGeneral Hospital Valjevo, Department of Quality Assurance, Valjevo, SerbiaIntroduction. Right heart thrombus (RHT) is a relatively rare phenomenon found in 4% of patients with acute pulmonary embolism (PE), and some reports show that the presence of RHT is associated with poor outcomes. The optimal treatment of patients with PE and RHT is still controversial, with no clear consensus. Case report. A 38-year-old woman with repeated chest pain and worsening dyspnea was admitted to the hospital. The echocardiographical exam showed a large thrombus floating in the right atrium, protruding through the tricuspid valve into the right ventricle. Massive bilateral pulmonary embolism was confirmed by computed tomography pulmonary angiogram. Bearing these findings in mind and due to the clinical and hemodynamic instability of the patient, thrombolytic therapy was immediately initiated (alteplase), which resulted in excellent clinical outcomes with no adverse events at follow-up. Conclusion. Treating patients with PE and RHT is very difficult. While waiting for the results of some future randomized clinical trials on this topic, the treatment of these patients should be based on current guidelines while also considering the patient’s hemodynamic stability.https://doiserbia.nb.rs/img/doi/0042-8450/2023/0042-84502200066R.pdftreatment outcomediagnosisechocardiographyheart ventriclesmultidetector computed tomographypulmonary embolism |
| spellingShingle | Ružičić Dušan Vuković Mira Right heart thrombus in a patient with acute pulmonary embolism - a practice in hide-and-seek with guidelines Vojnosanitetski Pregled treatment outcome diagnosis echocardiography heart ventricles multidetector computed tomography pulmonary embolism |
| title | Right heart thrombus in a patient with acute pulmonary embolism - a practice in hide-and-seek with guidelines |
| title_full | Right heart thrombus in a patient with acute pulmonary embolism - a practice in hide-and-seek with guidelines |
| title_fullStr | Right heart thrombus in a patient with acute pulmonary embolism - a practice in hide-and-seek with guidelines |
| title_full_unstemmed | Right heart thrombus in a patient with acute pulmonary embolism - a practice in hide-and-seek with guidelines |
| title_short | Right heart thrombus in a patient with acute pulmonary embolism - a practice in hide-and-seek with guidelines |
| title_sort | right heart thrombus in a patient with acute pulmonary embolism a practice in hide and seek with guidelines |
| topic | treatment outcome diagnosis echocardiography heart ventricles multidetector computed tomography pulmonary embolism |
| url | https://doiserbia.nb.rs/img/doi/0042-8450/2023/0042-84502200066R.pdf |
| work_keys_str_mv | AT ruzicicdusan rightheartthrombusinapatientwithacutepulmonaryembolismapracticeinhideandseekwithguidelines AT vukovicmira rightheartthrombusinapatientwithacutepulmonaryembolismapracticeinhideandseekwithguidelines |