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(Circulation. 2005;111:e438-e439.)
© 2005 American Heart Association, Inc.

Images in Cardiovascular Medicine

Free-Floating Thrombus in Right Heart and Massive Pulmonary Embolism Migrating Into Pulmonary Artery

Yoshihiro Noji, MD; Tohru Kojima, MD; Takahiko Aoyama, MD; Masato Yamaguchi, MD; Tsutomu Araki, MD; Susumu Fujino, MD; Katsuaki Yokota, MD; Noriko Kumamoto, MD; Takakiyo Nakaya, MD; Keiichiro Takase, MD; Masami Shimizu, MD; Hiroshi Mabuchi, MD

From the Department of Cardiology (Y.N., T. Aoyama, M.Y., T. Araki, S.F., K.Y.) and the Department of Respiratory Medicine (T.K., N.K., T.N., K.T.), Fukui Prefectural Hospital, Fukui, and the Molecular Genetics of Cardiovascular Disorders (Y.N., M.S., H.M.), Division of Cardiovascular Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.

Reprint requests to Yoshihiro Noji, MD, Department of Cardiology, Fukui Prefectural Hospital, Yotsui 2-8-1, Fukui 910-8526, Japan. E-mail nojibon@nifty.com

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 71-year-old man with chronic obstructive pulmonary disease (severe pulmonary emphysema with home oxygen therapy) was referred to our hospital because of 1-day history of dyspnea at rest. His physical examination was remarkable for tachycardia (110 bpm) and tachypnea (32 breaths/min). The ECG demonstrated sinus tachycardia, S waves in leads I and aVL, transition zone to V₅, and T-wave inversion in leads III and aVF. A transthoracic echocardiogram (TTE) performed on admission showed that the right atrium and right ventricle were apparently enlarged. The left ventricle had assumed a classic D-shaped configuration, which indicates impaired left ventricular relaxation, and severe tricuspid regurgitation was present. Systolic pulmonary artery pressure of up to 80 mm Hg was estimated on the basis of pulsed Doppler echocardiography. There were no signs of thrombus in the heart. Computed tomography of the chest revealed large thrombi in the right and left pulmonary arteries (Figure 1). The patient received immediate thrombolytic treatment with recombinant tissue plasminogen activator (Monteplase, Eisai Co, Ltd; 1 600 000 U) intravenously, followed by 15 000 U/d unfractionated heparin infusion over a 24-hour period, and both symptoms and pulse oximetry improved initially.

View larger version (23K): [in this window] [in a new window]   Figure 1. Computed tomographic study of thorax showed large thrombi in right (arrows in A) and left (arrows in B) pulmonary arteries.

However, on the fifth hospital day, he again became symptomatic, with acute deterioration of pronounced hypoxia. Simultaneous TTE revealed a large wormlike thrombus floating in the right atrium. The thrombus was highly mobile and eventually prolapsed . . . [Full Text of this Article]

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Circulation 2005 111: 3185. [Extract] [Full Text]

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