Abstract
Right heart thrombus in transit clot (RHTT) associated with a pulmonary thromboembolism (PTE) is a rare but potentially fatal diagnosis. Early diagnosis and immediate intervention are crucial. This report describes the case of a healthy, physically active 32-year-old female who presented 19 days postoperatively, following an anterior cruciate ligament reconstruction and partial lateral meniscectomy with a saddle PE, RHTT, and right ventricular (RV) strain. The patient received half of the standard dose of intravenous tissue plasminogen activator (TPA) in combination with anticoagulation and survived. Case reports of RHTT will inform future studies designed to evaluate whether and when thrombolysis should be administered.
Highlights
Right heart thrombus in transit clot (RHTT) is a rare complication of venous thromboembolism that occurs in up to 4% of patients with pulmonary embolism (PTE) with a very high mortality [1]
We describe the presentation, management, and outcome of a patient who presented with a saddle pulmonary thromboembolism (PTE), RHTT, and right ventricular (RV) strain who received half of the standard dose of intravenous tissue plasminogen activator in combination with anticoagulation
Discussion ough management of RHTT has not been well established in the literature, current treatment modalities include anticoagulation therapy, thrombolytic therapy, catheterdirected thrombolysis, and surgical embolectomy [3]
Summary
Thrombolysis of Postoperative Acute Pulmonary Embolism with a Thrombus in Transit. Received 18 October 2019; Revised 14 April 2020; Accepted 1 May 2020; Published 20 May 2020. Right heart thrombus in transit clot (RHTT) associated with a pulmonary thromboembolism (PTE) is a rare but potentially fatal diagnosis. Is report describes the case of a healthy, physically active 32year-old female who presented 19 days postoperatively, following an anterior cruciate ligament reconstruction and partial lateral meniscectomy with a saddle PE, RHTT, and right ventricular (RV) strain. E patient received half of the standard dose of intravenous tissue plasminogen activator (TPA) in combination with anticoagulation and survived. Case reports of RHTT will inform future studies designed to evaluate whether and when thrombolysis should be administered
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