Right Ventricular Thrombus in Transit: Raising the Stakes in the Management of Pulmonary Embolism.
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ABSTRACT:
SUBMITTER: Lai E
PROVIDER: S-EPMC6984981 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundCOVID-19 is a novel disease that has been associated with changes in haemostasis and increased risk of thrombosis, especially in patients who are critically ill.Case summarya 71-year-old patient presented to the emergency department with acute respiratory failure. The patient had been discharged from the hospital 1 day before, after apparent recovery of a proven COVID-19 infection. Relevant medical history reports polycythemia vera. The diagnostic work-up included a CT-scan of the thorax, revealing bilateral sub-segmental pulmonary embolism. An echocardiogram showed a dilated right ventricle with poor systolic function and a large multi-lobar thrombus. Forty-eight hours after initiation of treatment with therapeutic anticoagulation the thrombus was no longer seen on the echocardiogram.DiscussionThis case confirms the high risk of thrombosis in COVID-19 infection as has been described in recent literature. It demonstrates the severity of the coagulopathy given the presence of both bilateral sub-segmental pulmonary embolism and right ventricular thrombus, despite treatment with prophylactic anticoagulation. Remarkable in this case is the fact that the patient had a myeloproliferative neoplasm (polycythaemia vera). This is associated with an increased risk of thrombosis, especially in the presence of erythrocytosis, leucocytosis, and/or inflammation.
| S-EPMC7890674 | biostudies-literature
Project description:Right heart thrombus accompanied by chronic thromboembolic pulmonary hypertension is a rare entity. Right heart thrombus may develop in the peripheral veins or in situ within the right heart chambers. The diagnosis of right heart thrombus is challenging, since its symptoms are typically non-specific and its imaging features resemble those of cardiac masses. Here, we report two cases of right heart thrombus with chronic thromboembolic pulmonary hypertension that presented as right ventricular masses initially. Both patients underwent simultaneous pulmonary endarterectomy and resection of the ventricular thrombi. Thus, when mass-like features are confirmed by imaging, right heart thrombus should be suspected in patients with chronic thromboembolic pulmonary hypertension, and simultaneous right heart thrombus resection is required along with pulmonary endarterectomy.
| S-EPMC8127759 | biostudies-literature
Project description:A 95-year-old female with a history of dementia and atrial fibrillation (not on anticoagulation) presented to the emergency department (ED) by ambulance from her skilled nursing facility due to hypoxia. Point-of-care ultrasound was performed, and showed evidence of a large mobile thrombus in the right ventricle on apical four-chamber view. Further evidence of associated right heart strain was seen on the corresponding parasternal short-axis view. These ultrasound findings in combination with the patient's clinical presentation are diagnostic of acute pulmonary embolism with right heart strain. Point-of-care transthoracic cardiac ultrasound in the ED is an effective tool to promptly diagnose acute pulmonary embolism with right heart strain and thrombus in transit and guide further treatment.
| S-EPMC6366382 | biostudies-literature
Project description:This is the case of a 25-year-old obese man who presented with acute shortness of breath, chest pain, and palpitations. Of note, he lives a sedentary lifestyle and was recently hospitalized for incision and drainage of a left foot abscess. On presentation he was tachypnoeic, tachycardiac, and hypoxic but blood pressure was stable. Laboratory studies were significant for elevated D-dimer and mildly increased troponin. On further investigation he was found to have a saddle pulmonary embolism with massive clot burden. Echocardiogram revealed thrombus in transit and McConnell's sign. He underwent surgical embolectomy and closure of a patent foramen ovale. This is a particularly rare case, especially in such a young patient. Because this is a rare diagnosis, with insufficient data, there is no formally established treatment guideline. However, in patients who are good surgical candidates, studies have shown better outcome with surgical embolectomy as compared to anticoagulation alone or thrombolysis.
| S-EPMC5299177 | biostudies-literature
Project description:It has been stated that the interior of the right ventricle is as unique to each individual as one's fingerprint. This statement is backed by numerous publications which demonstrates considerable variation in the number, shape and configuration of papillary muscles inside the normal right ventricle.It has also been shown that these variants may be the cause of cardiac rhythm disorders.In this case report another potential complication of such right ventricular papillary muscle variants is proposed-these muscles may be the source of pulmonary emboli.The pathogenesis may be that of local stasis around these aberrant muscular structures and/or emboli may form inside the right ventricle as a result of cardiac rhythm disorders, induced by these muscles.It is proposed that in future the role of the right ventricle as the source of pulmonary emboli will become more apparent and an important part of the diagnostic work up in cases of idiopathic pulmonary embolism.
| S-EPMC2941134 | biostudies-literature
Project description:BackgroundPulmonary embolism with thrombus-in-transit through a patent foramen ovale is rare. It may present with neurological sequalae and rapid diagnosis is needed to prevent mortality and morbidity. The European Society of Cardiology (ESC) published guidelines in 2019 for diagnosis and management of acute pulmonary embolism which were useful in this case.Case summaryA 32-year-old sedentary male presented with sudden onset shortness of breath, syncope, a probable seizure, and chest pain. Investigations showed an acute pulmonary embolism with mobile thrombus in the right atrium and right ventricle and also thrombus-in-transit passing through a patent foramen ovale into the left atrium. He was resuscitated and rapidly transferred to theatre where he underwent surgical thromboembolectomy. There was difficulty in separating him from cardiopulmonary bypass due to right ventricular failure and he was initiated on extracorporeal membrane oxygenator support. He recovered fully and was discharged home after 43 days.DiscussionThis case report highlights the presentation of this rare diagnosis and discusses the management of acute pulmonary embolism according to recent ESC guidelines.
| S-EPMC8188862 | biostudies-literature
Project description:Time and dose related expression profiles of rat right heart tissue in microsphere bead model for Pulmonary embolism Keywords: Time course and dose response in experimental PE
2008-07-01 | GSE6104 | GEO
Project description:A 59-year-old female with a history of stage IV lung adenocarcinoma presented with worsening shortness of breath and cough over several weeks. She was tachycardic, hypotensive, and tachypneic. Portable chest x-ray suggested bilateral pleural effusions and computed tomography angiography (CTA) revealed bilateral pulmonary emboli (PE) with suspected right heart strain. Upon admission to the medical intensive care unit for treatment of PE, bedside echocardiography was performed to direct management. Indicators of cor pulmonale and right heart strain were apparent including right ventricle dilation, reduced tricuspid systolic excursion, and a deformed left ventricle with “D sign”. Most notably, a right atrial thrombus was detected, a finding not initially seen on CTA. Ultimately, prompt detection of the effects on the right ventricle by bedside echocardiography directed the next step in this patient's clinical course without delay.
| S-EPMC9618828 | biostudies-literature
Project description:A 28-year-old policeman presented with left lower limb deep vein thrombus, pulmonary embolism and a highly mobile right atrial clot. Thrombolytic therapy with IV Tenecteplase was administered. Within a few minutes after the Tenecteplase bolus, the patient's condition worsened dramatically with severe hypotension and hypoxemia. Immediate bedside transthoracic echocardiogram revealed that the mobile right atrium clot had disappeared completely presumably having migrated to the pulmonary circulation thus worsening the clinical condition. With intensive supportive measures the patient's condition was stabilized and he made a complete recovery. Prior to discharge, the echocardiogram revealed normal right ventricular function and a CT pulmonary angiogram performed after 2 months revealed near complete resolution of pulmonary thrombi. Thrombolytic therapy for right heart thrombus with pulmonary embolism can be a reasonable first line therapy but may be associated with hemodynamic worsening due to clot migration.
| S-EPMC3861324 | biostudies-literature
Project description:BackgroundRight ventricular (RV) function plays a critical role in the pathophysiology and acute prognosis of pulmonary embolism (PE). We analyzed the temporal changes of RV function in the cohort of a prospective multicentre study investigating if an early switch to oral anticoagulation in patients with intermediate-risk PE is effective and safe.MethodsEchocardiographic and laboratory examinations were performed at baseline (PE diagnosis), 6 days and 6 months. Echocardiographic parameters were classified into categories representing RV size, RV free wall/tricuspid annulus motion, RV pressure overload and right atrial (RA)/central venous pressure.ResultsRV dysfunction based on any abnormal echocardiographic parameter was present in 84% of patients at baseline. RV dilatation was the most frequently abnormal finding (40.6%), followed by increased RA/central venous pressure (34.6%), RV pressure overload (32.1%), and reduced RV free wall/tricuspid annulus motion (20.9%). As early as day 6, RV size remained normal or improved in 260 patients (64.7%), RV free wall/tricuspid annulus motion in 301 (74.9%), RV pressure overload in 297 (73.9%), and RA/central venous pressure in 254 (63.2%). At day 180, the frequencies slightly increased. The median NT-proBNP level decreased from 1448 pg/ml at baseline to 256.5 on day 6 and 127 on day 180.ConclusionIn the majority of patients with acute intermediate-risk PE switched early to a direct oral anticoagulant, echocardiographic parameters of RV function normalised within 6 days and remained normal throughout the first 6 months. Almost one in four patients, however, continued to have evidence of RV dysfunction over the long term.
| S-EPMC10562278 | biostudies-literature