Large embolus in transit - An unresolved therapeutic dilemma (case report and review of literature)

Floating right heart thrombus, also known as "emboli in transit" is a potentially fatal condition, of varying etiology and usually coexisting with massive pulmonary embolism. Although the mortality rate is as high as 40%, there are no established therapeutic guidelines. A case is presented of an 84 year old female with a history of colon cancer and coronary artery disease who presented with sudden onset unresponsiveness. She was intubated in the ED and started on intravenous pressor support. A free floating large right ventricular thrombus and dilated right ventricle were noted on transthoracic echocardiogram (TIE). She was managed medically with good. short term outcome. Floating right heart thrombus is a rare occurrence. Recognition of signs and symptoms along with early TIE is critical for diagnosis and consideration of treatment modality. The existing literature does not offer a clear consensus for management of pulmonary embolism with co-existing mobile intra-cardiac thrombus. Choice of treatment is crucial and should be considered on a case-by-case basis after careful assessment of indications, contraindications, risks and benefits.(C) 2014 Elsevier Inc. All rights reserved.