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Case Reports in Cardiology
Volume 2015, Article ID 364780, 4 pages
http://dx.doi.org/10.1155/2015/364780
Case Report

Free Floating Right Heart Thrombus Associated with Acute Pulmonary Embolism: An Unsettled Therapeutic Difficulty

1Department of Internal Medicine and Specialties, University of Yaounde 1, Yaounde, Cameroon
2Departement of Cardiology, Centre Hospitalier Guy Thomas, BP Box 167, 63204 Riom Cedex, France

Received 20 March 2015; Accepted 18 April 2015

Academic Editor: Tayfun Sahin

Copyright © 2015 Clovis Nkoke et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Free floating right heart thrombus is a rare phenomenon in the context of acute pulmonary embolism and it is associated with a poor outcome. The increased use of echocardiography has led to an increased detection of right heart thrombi. However, optimal management of free floating right heart thrombus remains controversial with no clear consensus. We present the case of a 74-year-old woman who presented to the emergency department with acute onset dyspnea on minimal exertion which had developed over a period of 1 day. A computed tomography of the chest demonstrated massive bilateral proximal pulmonary embolism. A bedside transthoracic echocardiography performed showed a moderately dilated, poorly functioning right ventricle with visible highly mobile serpiginous thrombus moving to and fro across the tricuspid valve. Thrombolytic therapy was immediately initiated with tenecteplase which resulted in excellent results. Although there is no clear consensus for the management of right heart thrombus associated with pulmonary embolism, thrombolysis is readily available and can be effective in carefully selected patients.