The dilemma in the management of haemodynamically stable pulmonary embolism with right heart thrombus

What is it about?

Right ventricular thrombus (RVT) can be life-threatening, since it has the potential to embolize and cause saddle pulmonary emboli. We present a patient who initially presented with hemodynamically stable pulmonary emboli with evidence of RVT on Echocardiogram. She was placed on heparin drip however, she later developed cardiac arrest and died due to embolization of RVT to the pulmonary vasculature. Although management of hemodynamically stable PE in patients with RVT is still a matter of debate [1], given the outcome we suggest that thrombolysis or emergent embolectomy at the presentation, in this case, may have had a favorable outcome.

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