title: The right atrial thrombus: the sword of Damocles with real risk of massive pulmonary embolism.
abstract: Cases of 6 patients admitted at the intensive care unit for massive pulmonary embolism are reported. All patients presented with dyspnea, tachypnea, and tachycardia, and 4 were hypotensive and had syncope. Lung ventilation/ perfusion scans revealed perfusion defects in 4 patients. Transthoracic echocardiography (TTE) demonstrated acute cor pulmonale. It also revealed mobile right atrial thrombi in 5 patients, adherent thrombus in the right atrium in 1 patient and patent foramen ovale in 4 patients. Thrombolytic therapy was initiated in 4 patients, and 2 patients received heparin infusion only. Effects of thrombolysis were monitored using bedside TTE during the first 24 hours and in follow-up. The outcome of 4 patients who received thrombolytic therapy was good whereas other 2 patients, who received only heparin, died. Thrombotic mass disappeared 8 to 12 hours after initiation of therapy, and 10 weeks after discharge TTE showed normalized right ventricle dimensions and function in all 4 patients.
authors.affiliation: Intensive Care Unit, Clinical Hospital Dubrava, Zagreb, Croatia. mkirin@kbd.hr
authors.forename: Marijan
authors.initials: M
authors.lastname: Kirin
authors.forename: Reuf
authors.initials: R
authors.lastname: Cerić
authors.forename: Marko
authors.initials: M
authors.lastname: Spoljarić
authors.forename: Mario
authors.initials: M
authors.lastname: Pehar
authors.forename: Gordana
authors.initials: G
authors.lastname: Cavrić
authors.forename: Ivana Rajćan
authors.initials: IR
authors.lastname: Spoljarić
authors.forename: Ivan
authors.initials: I
authors.lastname: Kirin
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006325:Heart Atria / Q000473:pathology; D006331:Heart Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000401:mortality; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality; D018570:Risk Assessment; D013300:Streptokinase / Q000627:therapeutic use; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000401:mortality; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006493:Heparin; D013300:Streptokinase