PMC8362882_01
(A,B) Modified short-axis view and four-chamber view showing irregular thrombotic mass pointing toward the tricuspid valve, into the right ventricle. (C) Venous phase, contrast CT scan with evidence of intraluminal hypo-dense filling defect, with irregular profile, nearly occluding an enlarged right atrium.
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F1
In the ED, he underwent transthoracic echocardiography (TTE) showing a dilated right atrium containing a 5.57 x 3.30 x 2.69 cm pedunculated mass, with irregular heterogeneous surface, attached to the superior atrial wall, partially crossing and nearly occluding the tricuspid valve (Figures 1A,B). Contrast CT described an intraluminal hypodense filling defect, with irregular profile, sparing the superior and inferior vena cava and being apparently attached to the atrial catheter of the pacemaker and the atrial portion of the ventricular catheter (Figure 1C).
(A,B) Bilateral thrombotic apposition nearly occluding the pulmonary arteries and causing bilateral massive pulmonary embolism. (C) Nearly complete detachment of the thrombus from the right atrium, which is now only in part visible in proximity to the atrial catheter.
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F2
Emergency CT angiography showed a complete detachment of the atrial thrombus into the pulmonary arteries (Figures 2A,B). The same exam showed the presence of small residual thrombotic apposition across the atrial catheter (Figure 2C).