Case Report: Right Atrial Thrombus with Pulmonary Embolism - Effect of Timely Medical Treatment

Charles O Masese¹*, Joyce Chepkoech², Timothy Wachira³, Anthony Gikonyo⁴, Premanand Ponoth⁵ and Dan Gikonyo^4
1Head Cardiology Lecturer, The Karen Hospital Medical Training College, Langata Road, Nairobi 00200, Kenya
²Cardiology student, The Karen Hospital Medical Training College, Langata Road, Nairobi 00200, Kenya
³Lecturer, The Karen Hospital Medical Training College, Langata Road, Nairobi 00200, Kenya
⁴Cardiologist, The Karen Hospital Medical Training College, Langata Road, Nairobi 00200, Kenya
⁵Chief of Cardiothoracic & Vascular Surgery, The Karen Hospital Medical Training College, Langata Road, Nairobi 00200, Kenya
*Corresponding Author: Charles O Masese, Head Cardiology Lecturer, The Karen Hospital Medical Training College, Langata Road, Nairobi 00200, Kenya.

Published: October 01, 2024

DOI: 10.55162/MCMS.07.246

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Abstract  

Background: Right atrial thrombus (RAT) is a rare finding that is almost exclusively found complicating pulmonary embolism (PE) and carries a high mortality rate. Emergency treatment is usually required to save life. There is no algorithmic approach of the management of this condition due to the lack of evidence-based guidelines and randomized control trials. Management of RAT is still a subject of debate.

Objective: This study demonstrates the effectiveness of thrombolysis in resolution of right atrial thrombus.

Case Report: Sixty one year-old female, presented with a history of fainting, exertional dyspnea, easy fatigability, and lower limb swelling. A transthoracic echocardiography (TTE) showed a right atrial mass that was moving into right ventricle. Computed tomography pulmonary angiogram (CTPA) confirmed a diagnosis of pulmonary embolism.

The patient was thrombolysed with tenectaplase and a repeat TTE confirmed that the thrombus had resolved with and improvement in the patient’s clinical symptoms.

Discussion: This demonstrates thrombolysis is a rapid and life-saving therapeutic measure reducing the risk of death from thromboembolism.

Keywords: Cardiac Thrombus; Pulmonary Thromboembolism; Thrombolysis

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