Successful outcome with outpatient acenocoumarol therapy for echocardiographically visible pulmonary thrombus

Abstract

Visualisation of thrombus in the main pulmonary artery through two-dimensional transthoracic echocardiography (TTE) without cardiovascular instability is rare. We report a unique case of echocardiographically diagnosed acute pulmonary embolism (PE) in an ambulatory patient with concomitant cor pulmonale secondary to idiopathic interstitial lung disease. The mobile thrombus was first visualised at the junction of bifurcation of the pulmonary trunk with left pulmonary artery through routine two-dimensional TTE. Two days later, the contrast-enhanced computerised tomographic scan of the chest showed the thrombus to be in the distal portion of the right pulmonary artery. Complete resolution of pulmonary thrombus was achieved with a 3-month course of outpatient oral anticoagulation treatment with acenocoumarol without recurrence of PE during the 1-year follow-up.