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January 10, 2026DiagnosticsOpen Access

Ultrasound Images That Speak: Assessing the Therapeutic Decision in the Emergency Department Regarding the Risk–Benefit Ratio of Systemic Thrombolysis in Intermediate-High-Risk Pulmonary Embolism—A Case Report

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Why the study?

Managing acute PE in hemodynamically stable patients with minimal symptoms remains challenging, especially when complicated by mobile right atrial thrombus.

Does systemic thrombolysis with Alteplase improve right ventricular function and resolve intracardiac thrombus in hemodynamically stable patients with intermediate-high-risk pulmonary embolism and a mobile right atrial thrombus?

Population

A 65-year-old male with acute PE, severe RV dysfunction, and mobile intracardiac thrombus

Design

Case report

Follow-up

2 h

Key result

Early systemic thrombolysis with Alteplase successfully resolved a large mobile thrombus and improved RV function in a patient with intermediate-high-risk pulmonary embolism.

Authors

AGAdela GoleaRTRaluca Mihaela TatCACarina Adam

Discussion

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Member takes

Overview

May support early thrombolysis in select stable intermediate-high-risk PE with mobile thrombus; hypothesis-generating and leaves open need for RCTs.

Key Points

  • The aim is to evaluate the role of point-of-care ultrasound in therapeutic decisions for patients with pulmonary embolism.
  • Case report of a 65-year-old male with a history of chronic venous insufficiency.
  • Utilization of point-of-care transthoracic echocardiography to assess cardiac function and thrombus presence.
  • Initiation of systemic thrombolysis with Alteplase guided by ultrasound findings.
  • Successful thrombolysis resulted in complete resolution of the intracardiac thrombus.
  • Significant improvement in right ventricular function observed after treatment.
  • No hemorrhagic complications reported during or after thrombolysis.

Structured PICO

Does systemic thrombolysis with Alteplase improve right ventricular function and resolve intracardiac thrombus in hemodynamically stable patients with intermediate-high-risk pulmonary embolism and a mobile right atrial thrombus?

P
Population
65-year-old male with intermediate-high-risk pulmonary embolism, severe right ventricular dysfunction, and a large mobile intracardiac thrombus prolapsing through the tricuspid valve, hemodynamically and respiratory stable.
I
Intervention
Systemic thrombolysis with Alteplase (100 mg over 2 h)
O
Outcome
Resolution of intracardiac thrombus and improvement of right ventricular functionsurrogate

Early systemic thrombolysis guided by POCUS-TTE may be effective and safe for intermediate-high-risk pulmonary embolism complicated by a mobile intracardiac thrombus, even in hemodynamically stable patients.

Cite This Study

Golea et al. (2025) studied this question. Early systemic thrombolysis with Alteplase successfully resolved a large mobile thrombus and improved RV function in a patient with intermediate-high-risk pulmonary embolism.

synapsesocial.com/papers/6963222d91e05aa366cb8bb8https://doi.org/10.3390/diagnostics16010048
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Randomized, Controlled Trial of Ultrasound-Assisted Catheter-Directed Thrombolysis for Acute Intermediate-Risk Pulmonary Embolism2013 · 1,142 citations
  2. 2Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension2011 · 2,240 citations
  3. 3Comparison of half-dose alteplase and LMWH in intermediate-high risk pulmonary embolism: a single-center observational study2025 · 1 citations
  4. 4Epidemiology, Etiology, and Pathophysiology of Pulmonary Embolism2024 · 30 citations
  5. 5Point-of-Care Ultrasound—History, Current and Evolving Clinical Concepts in Emergency Medicine2023 · 59 citations