Free floating right atrial thrombus with massive pulmonary embolism:near catastrophic course following thrombolytic therapy

Indian Heart J. 2013 Jul-Aug;65(4):460-3. doi: 10.1016/j.ihj.2013.06.015. Epub 2013 Jul 12.


A 28-year-old policeman presented with left lower limb deep vein thrombus, pulmonary embolism and a highly mobile right atrial clot. Thrombolytic therapy with IV Tenecteplase was administered. Within a few minutes after the Tenecteplase bolus, the patient's condition worsened dramatically with severe hypotension and hypoxemia. Immediate bedside transthoracic echocardiogram revealed that the mobile right atrium clot had disappeared completely presumably having migrated to the pulmonary circulation thus worsening the clinical condition. With intensive supportive measures the patient's condition was stabilized and he made a complete recovery. Prior to discharge, the echocardiogram revealed normal right ventricular function and a CT pulmonary angiogram performed after 2 months revealed near complete resolution of pulmonary thrombi. Thrombolytic therapy for right heart thrombus with pulmonary embolism can be a reasonable first line therapy but may be associated with hemodynamic worsening due to clot migration.

Keywords: Embolism; Right atrial thrombus; Thrombolysis.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Coronary Thrombosis / diagnostic imaging
  • Coronary Thrombosis / drug therapy*
  • Coronary Thrombosis / etiology
  • Echocardiography
  • Fibrinolytic Agents / therapeutic use
  • Humans
  • Male
  • Pulmonary Embolism / diagnostic imaging
  • Pulmonary Embolism / drug therapy*
  • Pulmonary Embolism / etiology
  • Tenecteplase
  • Thrombolytic Therapy
  • Tissue Plasminogen Activator / therapeutic use*
  • Venous Thrombosis / complications*


  • Fibrinolytic Agents
  • Tissue Plasminogen Activator
  • Tenecteplase