Free-floating right atrium thrombus associated with acute pulmonary thromboembolism.

Mobile right heart thrombus represents a rare situation that complicates acute pulmonary thromboembolism and is associated with high rates of mortality. In such cases, anticoagulation with heparin, thrombolysis, surgical embolectomy or percutaneous catheter intervention represent possible therapeutic measures, but no certain guideline recommendations have been proposed for this particular setting and the treatment should be conducted by guiding after local possibilities and experience. We present the case of a 69-year old male patient, with stable vital signs, that was admitted for acute pulmonary thromboembolism. Transthoracic echocardiography revealed right heart dilatation, acute pulmonary artery hypertension (PAH) and a serpiginous mobile thrombus located in the right atrium prolapsing into the right ventricle (RV) with maximum length 54 mm. After 24 hours of thrombolysis with streptokinase, the patient evolution was favorable, with disappearance of thrombus, RV function improvement and reduction of PAH. No post-thrombolysis complications were observed and the patient was discharged with indication of oral anticoagulation for long term. [ABSTRACT FROM AUTHOR]