Pulmonary embolism and intracardiac thrombi - individual therapeutic procedures

Mobile right heart thrombus is a severe but rare presentation of thromboemb olic disease and usually coexists with an already massive pulmonary embolis m (PE). But looking at the literature there is no clear consensus on therap eutic management. We therefore tried to find possible therapeutic guideline s and to evalute an optimal diagnostic procedure looking at three patients who presented at our department with mobile right heart thrombbus in the la st year. The first patient with a small (diameter = 1 cm) thrombus in the r ight ventricle and peripheral pulmonary embolism underwent successful throm bolytic therapy without any complications. Patients II and III showed large intracardiac masses, in patient III extending into the superior vena cava, with central PE. These two patients underwent pulmonary arteriotomy. The d iagnostic line in each case was transthoracal echocardiography followed by a helix lung CT scan. Only patients with small intracardiac thrombi and thr ombotic masses in the peripheral pulmonary arteries but with hemodynamicall y significant PE should be treated with thrombolytic agents.