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76 A70-year-old male patient with a known history of hypertension, rheumatic heart disese and hemorrhagic stroke was admitted to our hospital with dyspnea and palpitation. His symptoms started 2 days before his admission. On physical examination, he had 2/6 systolic murmur at the apex. Electrocardiography (ECG) revealed atrial fibrillation. Two-dimensional transthoracic echocardiographic examination at apical four chamber and subcostal views showed regular noncalcific mass freely moving at systole and diastole in right atrium (RA) and right ventricle (RV) (Figure 1, 2 and Video 1). Two-dimensional transthoracic echocardiograpic examination also revealed rheumatic mitral disease with moderate mitral regurgitation and mitral stenosis and moderate tricuspit regurgitation with dilated RA and RV. Estimated pulmonary artery pressure was measured 70 mmHg with continuous wave Doppler examination. In order to evaluate pulmonary artery embolus computed tomography (CT) scan obtained. Multislice CT scan confirmed bilateral pulmonary emboli (PE) with no thrombus in RV and RA after 2 hours from the admission (Figure 3). On echocardiographic follow up examination this mass was disappeared and dilation in right heart chamber was slightly increased (Figure 4). The patient was not given thrombolytic therapy because of the recent history of hemorrhagic stroke. Patient was started on iv heparin treatment and consulted to cardiovascular surgery immediately for right heart thrombus. While the patient was being prepared to surgery he developed sudden hemodynamic collapse. At that time patient was evaluated for catheter embolectomy but due to his medical condition he could not be taken to catheter laboratory and eventually died.

Massive Mobile Thrombus in the Right Heart Chambers and Ensuing Massive Pulmonary Embolism Due to Migration of This Thrombus: Original Image