title: Free floating right atrial thrombus with massive pulmonary embolism:near catastrophic course following thrombolytic therapy.
abstract: A 28-year-old policeman presented with left lower limb deep vein thrombus, pulmonary embolism and a highly mobile right atrial clot. Thrombolytic therapy with IV Tenecteplase was administered. Within a few minutes after the Tenecteplase bolus, the patient's condition worsened dramatically with severe hypotension and hypoxemia. Immediate bedside transthoracic echocardiogram revealed that the mobile right atrium clot had disappeared completely presumably having migrated to the pulmonary circulation thus worsening the clinical condition. With intensive supportive measures the patient's condition was stabilized and he made a complete recovery. Prior to discharge, the echocardiogram revealed normal right ventricular function and a CT pulmonary angiogram performed after 2 months revealed near complete resolution of pulmonary thrombi. Thrombolytic therapy for right heart thrombus with pulmonary embolism can be a reasonable first line therapy but may be associated with hemodynamic worsening due to clot migration.
authors.affiliation: Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India.
authors.forename: Ravindranath Khandenahally
authors.initials: RK
authors.lastname: Shankarappa
authors.forename: Ravi S
authors.initials: RS
authors.lastname: Math
authors.forename: Srinivas
authors.initials: S
authors.lastname: Papaiah
authors.forename: Yeriswamy M
authors.initials: YM
authors.lastname: Channabasappa
authors.forename: Satish
authors.initials: S
authors.lastname: Karur
authors.forename: Manjunath Cholenahally
authors.initials: MC
authors.lastname: Nanjappa
mesh_terms: D000328:Adult; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D004452:Echocardiography; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D000077785:Tenecteplase; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D020246:Venous Thrombosis / Q000150:complications*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator; D000077785:Tenecteplase
keywords: Embolism; Right atrial thrombus; Thrombolysis