RIGHT ATRIAL THROMBUS IN PULMONARY-EMBOLI SM - CONTRIBUTION OF ECHOCARDIOGRAPHY AND INDICATION FOR THROMBOLYTIC THERAPY

The presence of a right atrial thrombus is a recognized predictive fac tor of high mortality in patients with pulmonary embolism. In this rep ort we describe two cases in which a free-floating thrombus in the rig ht atrium was demonstrated by echocardiography; it resolved rapidly in both cases after thrombolytic therapy which resulted in a rapid clini cal improvement and favorable outcome. During the acute phase of pulmo nary embolism, a dilated right ventricle, a dilated pulmonary artery, a left ventricle of small size and paradoxical motion of the intervent ricular septum can be detected by echocardiography. In cases of massiv e pulmonary embolism or when there is doubt regarding the diagnosis, t his noninvasive method serves to guide diagnostic and therapeutic deci sions. In the special case where a right atrial thrombus is detected b y echocardiography, thrombolytic therapy seems warranted.