Key result
Warfarin resolves a 3 cm tricuspid valve thrombus complicated by widespread bilateral PE.
Why the study?
Right heart thrombus complicated by pulmonary embolism typically presents as an emergency with haemodynamic instability, but less is known about subacute presentations.
Case Report (n=1)
Early trans-thoracic echocardiogram is crucial in detecting right heart thrombus in patients suspected of pulmonary embolism, even in subacute presentations, and can be successfully managed with warfarin.
Answers are grounded in this paper and cite their sources.
Supports anticoagulation for right heart thrombus with PE in select cases; leaves open need for prospective studies.
BACKGROUND: Right heart thrombus (RHTh) complicated by pulmonary embolism (PE) usually presents as a medical emergency with significant haemodynamic instability. However, less is known about subacute presentations. CASE SUMMARY: We present a 74-year-old haemodynamically stable gentleman with a 3-week history of mild pleuritic chest pain and exertional dyspnoea preceded by lower respiratory tract infection. Early trans-thoracic echocardiogram (TTE) revealed a 3 cm elongated tricuspid valve thrombus with right ventricular dysfunction, new-onset atrial fibrillation, and new-onset severe left ventricular impairment. Subsequent computed tomography pulmonary angiogram showed widespread bilateral pulmonary emboli with retrograde opacification of the hepatic veins. The RHTh successfully resolved with warfarin therapy with no further complications, and the patient was discharged on Day 8 of hospitalization. DISCUSSION: An early TTE is crucial in detecting the RHTh in patients suspected of PE and can significantly change the management compared with uncomplicated PE. The index of suspicion for PE and RHTh should remain high even in subacute cases.
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Myslivecek et al. (2021) conducted a case report in Tricuspid valve thrombus complicated by pulmonary embolism (n=1). Warfarin therapy was evaluated on Resolution of right heart thrombus. Warfarin therapy successfully resolved a subacute 3 cm tricuspid valve thrombus complicated by widespread bilateral pulmonary emboli in a 74-year-old man, with no further complications.
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