Thrombolysis for saddle pulmonary embolism and 3-chamber thrombus.
Currently, the only widely accepted indication for thrombolysis in cases of pulmonary embolism is hemodynamic instability. However, the presence of a right-heart thrombus along with pulmonary embolism is a poor prognostic indicator, and the use of thrombolytic agents should also be considered in this circumstance. Furthermore, despite a risk of distal embolization, thrombolytic therapy may be implemented if the intracardiac thrombus also straddles a patent foramen ovale. Herein, we present the case of a 92-year-old woman who presented at our institution after a syncopal event and multiple recent episodes of amaurosis fugax. Transthoracic echocardiography revealed a mobile right-heart thrombus that extended through a patent foramen ovale into the left atrium. Computed tomography of the chest showed a saddle pulmonary embolus. We used thrombolytic therapy to treat the patient, and imaging showed complete resolution of the thrombus and the embolism 2 days later.
Salman
Tariq
T
J. Willis Hurst Internal Medicine Residency Program, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia 30303, USA. tsalman@emory.edu
Satija
Sameer
S
Martin
Stephanie F
SF
Sperling
Laurence
L
D000369:Aged, 80 and over; D003327:Coronary Disease / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D004452:Echocardiography; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications; D006801:Humans; D011655:Pulmonary Embolism / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
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