Massive Pulmonary Embolism with Right Atrial Thrombus: A Case Report

We present the case of a 53-year-old woman who arrived at the emergency department with acute dyspnea persisting for 24 hours. The purpose of this report is to highlight an unusual presentation of massive pulmonary embolism (PE) combined with right atrial thrombi and to underscore the diagnostic and therapeutic considerations in such complex cases. Despite initial hemodynamic stability, a comprehensive diagnostic evaluation revealed a massive PE affecting both pulmonary arteries, along with multiple thrombi in the right atrium (RA) – a rare and high-risk combination in PE management. Elevated D-dimer levels, computed tomography pulmonary angiography (CTPA), and transthoracic echocardiography (TTE) confirmed the diagnosis. The patient responded well to anticoagulation therapy, achieving significant clinical improvement. This case is notable due to the concurrent presence of right atrial thrombi and massive PE in a patient with no identifiable risk factors, such as atrial fibrillation, cancer, or recent surgery, suggesting an idiopathic cause. This report provides an example within the field of PE management where individualized treatment and comprehensive diagnostic workup are essential, particularly in atypical presentations without clear predisposing factors.