Introduction
Venous thromboembolism, including pulmonary embolism (PE), is a common
disease that carries significant morbidity and mortality. The presence
of heart right thrombus (RHT) in
the absence of atrial fibrillation, structural heart disease, or
catheters in situ is rare and almost exclusively found in the presence
of clinical manifestations of PE. The reported incidence of a RHT
associated with high-risk PE ranges from 3% to 23% (1). However, the
prevalence of a RHT in patients with a diagnosis of PE is increased in
those who have hypotension, severe hypoxemia, and right ventricular
strain.
In view of the reported high mortality, it constitutes a medical
emergency and requires immediate treatment. Currently, a widely accepted
indication for interventional treatment in cases of pulmonary embolism
is hemodynamic instability or cardiogenic shock (2). However, the
presence of a right-heart thrombus along with pulmonary embolism is a
poor prognostic indicator, and catheter directed thrombolysis with use
of thrombolytic agents should also be considered in this circumstance.
Although there are different treatment options for PE, the
optimal management of right ventricular thrombus is still uncertain.
Here, we present a successful treatment of an 81-year-old woman who had
a bilateral high-risk PE and free floating intracardiac thrombus with
Acoustic Pulse thrombolysis using the EKOS EkoSonic system (Boston
Scientific Corporation, USA).