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).