PMC4941566_01
Series of transesophageal echocardiographic images demonstrating a highly mobile, homogenously echogenic right atrial mass.
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A highly mobile right atrial mass was visualised prolapsing across the tricuspid orifice during diastole, with associated moderate tricuspid regurgitation (Fig. 1).
Computed tomography pulmonary angiogram showing extensive bilateral filling defects in the right and left main pulmonary arteries.
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Limited TOE views of the right main pulmonary artery were suggestive of pulmonary embolism and extensive bilateral emboli were later confirmed on computed tomography pulmonary angiography (Fig. 2).
Specimen excised from the right atrium at surgery. Substantial clot was also extracted from the pulmonary arteries under direct vision.
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On opening the right atrium, an organised 55 mm x 25 mm thrombus with a short pedicle was seen adherent along the lower margin of the crista terminalis (Fig. 3).
Organised thrombus composed of platelets and fibrin with entrapped red blood cells.
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Histological examination of the atrial mass revealed laminated fragments of dead blood cells and fibrin consistent with organised thrombus (Fig. 4).