“Thrombus in transit” – the role of echocardiography in the diagnosis of massive pulmonary embolism and a review of the literature

Abstract

The diagnosis of acute pulmonary embolus is often difficult.We present a case history where bedside transthoracic echocardiography provided a rapid and convenient aid to diagnosis by demonstrating a venous “thrombosis in transit” as a spiral shaped mass in the right atrium prolapsing into the right ventricle.We also review the management and outcome in recent, similar cases. Overall mortality is 33% for pulmonary embolus and associated thrombus in transit.Transthoracic echocardiography may be a useful tool in the diagnosis of pulmonary embolus. The presence of thrombus in the right heart is a rare finding. The outcome in these patients is determined by the clinical presentation rather than by the identification of thrombus.