Publish in this journal
Journal Information
Vol. 68. Issue 4.
Pages 338 (April 2015)
Download PDF
More article options
Vol. 68. Issue 4.
Pages 338 (April 2015)
Image in cardiology
DOI: 10.1016/j.rec.2014.04.022
Full text access
Multiple Intracardiac Thrombi Complicated by Pulmonary Embolism
Trombos intracardiacos múltiples complicados por embolia pulmonar
Felipe H. Valle
Corresponding author

Corresponding author:
, Géris Mazzuti, Angela Barreto Santiago Santos
Division of Cardiology, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
Article information
Full Text
Download PDF
Figures (3)
Show moreShow less
Full Text

In January 2014, a 22-year-old woman with a known diagnosis of peripartum dilated cardiomyopathy presented to the emergency department with a 3-week history of dyspnea and orthopnea. The symptoms had worsened in the previous night. The initial evaluation included an echocardiogram showing thrombi in the left ventricular (Figure 1, stripes), left atrial (Figure 2A, arrow) and right ventricular (Figure 2B, arrows) chambers. The left atrial and one of the right ventricular images were less dense, suggesting recently formed thrombi. Pulmonary embolism was excluded by chest computed tomography angiography. During the admission, the patient was started on oral anticoagulation therapy with warfarin and was discharged in the therapeutic range (international normalized ratio [INR]=2.6). One month after discharge, she was readmitted to the emergency department with hemoptysis. At that point, despite an INR of 2.1, a new chest computed tomography angiography demonstrated pulmonary embolism. The left atrial and right ventricular thrombi with recent thrombus characteristics reported in the previous echocardiography were not seen in a follow-up echocardiography (Figure 3, stripes show a smaller left ventricular thrombus and the arrow shows a smaller right ventricular thrombus).

Figure 1
Figure 2
Figure 3

Multi chamber intracardiac thrombi are rare. In our patient, the pulmonary embolism was probably caused by migration of the intracardiac thrombi to the pulmonary arteries. One particularity of this case was that even despite anticoagulation therapy, the patient developed a new episode of pulmonary embolism. The role of new oral anticoagulants in this situation is unknown. In addition to anticoagulation, we could mention surgical thrombectomy as an alternative treatment for intracardiac thrombosis. However, the optimal management in this scenario is unclear.

Copyright © 2014. Sociedad Española de Cardiología
Revista Española de Cardiología (English Edition)

Subscribe to our newsletter

Article options
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?