Right heart thrombus-in-transit with pulmonary embolism in a patient with primary hypercoagulable state

Inas Eweda, Sameh Samir, Osama Abbas, Ghada El-Gohary, Wail Nammas
2010 Cardiology Journal   unpublished
A 25 year-old female with a history of Caesarian section ten weeks ago presented with symptoms suggestive of pulmonary embolism. Transthoracic echocardiography revealed a free--floating large thrombus traversing the right atrial cavity. Transesophageal echocardiography confirmed the presence of an unattached thrombus that originated from the most proximal part of the inferior vena cava. Multi-slice computed tomography of the chest and abdomen revealed the thrombus to start from the
more » ... part of the inferior vena cava and extend through the right atrium. It also demonstrated multiple thrombi in the pulmonary vasculature, the largest being in the right main pulmonary artery and its lower lobe branch. The patient was triaged for surgical embolectomy under cardio-pulmonary bypass. Follow-up trans-thoracic and transesophageal echocardiography confirmed adequate removal of the thrombus. By genetic examination, she proved to have factor V 'Leiden' gene and two thrombophilia genes, all of which were positive in the heterozygous state. She had also a high serum homocysteine. (Cardiol J 2010; 17, 4: 408-411)