Key result
Right atrial thrombus in transit spontaneously embolizes to pulmonary arteries, demonstrating high embolization risk.
Why the study?
Right atrial thrombi are rare, life-threatening findings carrying high risk of embolisation and mortality, requiring rapid decision-making.
This case illustrates the rapid natural history and spontaneous embolization of a right atrial thrombus in transit, highlighting the critical role of multimodality imaging in diagnosis and management.
Supports urgent multimodality imaging for right atrial thrombi in transit; hypothesis-generating for natural history and management.
Right atrial (RA) thrombi are rare but life‐threatening findings, often representing ‘clot in transit’ with a high risk of embolisation and mortality. Their identification often signals an impending pulmonary embolic event and calls for rapid, thoughtful decision‐making. We report the case of a 65‐year‐old man with atrial fibrillation on rivaroxaban who presented with acute ischaemic stroke and was subsequently found to have a large RA thrombus. Shortly thereafter, he developed hypoxia, and computed tomography (CT) pulmonary angiography revealed bilateral pulmonary emboli. Interventional angiography was performed for planned thrombectomy, but the clot was no longer visualised, confirming spontaneous embolisation. Repeat echocardiography demonstrated complete resolution of the thrombus. This case highlights the natural history of RA thrombus in transit, the pivotal role of multimodality imaging and the challenges of management in patients with concurrent contraindications to thrombolysis.
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Qaraghuli et al. (2026) studied this question. A right atrial thrombus in transit spontaneously embolized to the pulmonary arteries, demonstrating the rapid natural history and high embolization risk of these rare cardiac masses.
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