Echocardiographic detection of pulmonary embolism in transit: implications for institution of thrombolytic therapy
Fisman, D.N.; Malcolm, I.D.; Ward, M.E.
Canadian Journal of Cardiology 13(7): 685-687
1997
ISSN/ISBN: 0828-282X PMID: 9251581 Document Number: 470130
Right atrial or ventricular thrombi in patients with pulmonary embolism are emboli in transit and are a medical emergency because they are associated with a high mortality rate when treated conservatively with anticoagulation. The current standard therapy is surgical embolectomy, while the use of thrombolytic therapy is less well accepted because of the risk of clot fragmentation and distal embolization. A case in which an unsuspected right ventricular thrombus was diagnosed by echocardiography is reported. This finding led to treatment with streptokinase (250,000 U, followed by 100,000 U/h for 24 h). Clinical improvement was rapidly obtained and the thrombus disappeared 10 h after the initial study. There was no complication. The case illustrates the utility of two-dimensional echocardiography in the evaluation of patients with pulmonary embolic disease and the efficacy and safety of thrombolytic therapy in the treatment of pulmonary embolism in transit.