Right Ventricular Thrombus Presenting With Right Ventricular Failure in Septic Shock: A Case Report

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: 78-year-old woman with coronary artery disease, type 2 diabetes mellitus, hypertension, hyperlipidemia, obesity presenting with refractory multifactorial shock initially managed as septic shock complicated by acute kidney injury and right ventricular thrombus with failure (n=1). Intervention: Anticoagulation with weight-based heparin infusion. Primary outcome: Resolution or improvement of shock state and right ventricular failure.

Q: What does this research mean for the field?

In patients with septic shock complicated by right ventricular thrombus and failure, anticoagulation alone may fail to prevent multiorgan failure when acute kidney injury contraindicates contrast imaging and advanced interventions. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

M. Harris

doi:10.7759/cureus.103900

February 19, 2026CureusOpen Access

Right Ventricular Thrombus Presenting With Right Ventricular Failure in Septic Shock: A Case Report

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Why the study?

To highlight clinical decision-making in refractory multifactorial shock when standard contrast imaging is contraindicated by acute kidney injury.

Key Points

Highlight clinical decision-making and management strategies in refractory multifactorial shock when standard contrast imaging is contraindicated due to acute kidney injury.
Evaluated a patient presenting with suspected septic shock secondary to a urinary tract infection who developed refractory hemodynamic instability.
Performed bedside echocardiography and clinical risk stratification when acute renal failure precluded contrast-enhanced computed tomography and instability precluded ventilation/perfusion scanning.
Initiated anticoagulation and tailored hemodynamics while assessing feasibility of interventional procedures, systemic thrombolysis, and renal replacement therapy.
Echocardiography revealed severe right ventricular systolic dysfunction and a large right ventricular thrombus, establishing mixed septic, cardiogenic, and suspected obstructive shock.
Neither mechanical thrombectomy nor systemic thrombolytic therapy could be pursued due to severe decompensation, prohibitive hemorrhage risk, and acute kidney injury.
Management transitioned from aggressive sepsis fluid resuscitation to fluid restriction and anticoagulation before the patient transitioned to comfort care after dialysis was declined.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

1 78-year-old woman with a history of CAD post-PCI, type 2 diabetes, hypertension, hyperlipidemia, and obesity presenting with altered mental status, acute kidney injury, and multifactorial shock (septic, cardiogenic, and obstructive) with right ventricular failure and right ventricular thrombus.

I

Intervention

Weight-based heparin infusion, broad-spectrum antibiotics, and vasopressor support (norepinephrine).

O

Outcome

Clinical course and patient survival.

This case highlights the diagnostic and therapeutic challenges of managing multifactorial shock with right ventricular failure and thrombus when standard contrast imaging is contraindicated due to acute kidney injury.

Limitations

Single patient case report limiting generalizability
No comparator group or quantitative effect size
Inability to obtain contrast imaging to confirm pulmonary embolism
High procedural risks limited treatment options
Outcomes influenced by multifactorial shock and comorbidities
Single case report
Diagnostic limitations due to acute renal failure preventing contrast-enhanced imaging

Implication

Emphasizes caution managing RV thrombus in septic shock with AKI; leaves open optimal anticoagulation strategies.

Abstract

We present a case report of refractory multifactorial shock initially managed as septic shock, requiring multidisciplinary collaboration when the diagnostic pathway was limited by acute kidney injury; the primary learning objective is to highlight clinical decision-making in shock when standard contrast imaging is contraindicated. Echocardiography revealed right ventricular failure with right ventricular thrombus, and pulmonary embolism was strongly suspected but could not be confirmed due to the inability to obtain contrast imaging. Persistent shock prompted a transition from a septic shock-directed strategy to cardiogenic and obstructive shock management. The patient was treated with anticoagulation but was not a candidate for mechanical thrombectomy. The course was complicated by progressive renal failure, and after dialysis was declined by the family, the patient was transitioned to comfort care.

Discussion

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Cite This Study

M. Harris (2026) conducted a case report in 78-year-old woman with coronary artery disease, type 2 diabetes mellitus, hypertension, hyperlipidemia, obesity presenting with refractory multifactorial shock initially managed as septic shock complicated by acute kidney injury and right ventricular thrombus with failure (n=1). Anticoagulation with weight-based heparin infusion was evaluated on Resolution or improvement of shock state and right ventricular failure.

synapsesocial.com/papers/69994c27873532290d020727 https://doi.org/10.7759/cureus.103900

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Right Ventricular Thrombus Presenting With Right Ventricular Failure in Septic Shock: A Case Report

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Right Ventricular Thrombus Presenting With Right Ventricular Failure in Septic Shock: A Case Report

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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