A CLOG IN THE RV: RIGHT VENTRICULAR THROMBUS IN TRANSIT

TOPIC: Pulmonary Vascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Right ventricular (RV) thrombi are an uncommon condition associated with pulmonary embolism. They may form within the cardiac chamber due to structural heart disease or presence of foriegn objects such as a assist device, represent thrombus in transit from peripheral source. We present case and imaging patient who presented extensive thrombosis involving right ventricle arteries, context periprocedural interruption anticoagulant therapy. CASE PRESENTATION: A 35-year-old woman history hypothyroidism, polycystic ovaries, recently diagnosed metastatic cholangiocarcinoma sudden onset sided sharp chest pain shortness breath, association left calf pain. She had been on rivaroxaban for venous thromboembolism, which interrupted peri-procedurally implantation port. Physical examination was notable hypoxia (oxygen saturation 85% room air), hypotension (96/48 mm Hg), tachypnea, signs respiratory distress. Laboratory workup showed elevated N-terminal proBNP (748 pg/mL), normal troponin. Computed tomography (CT) contrast demonstrated large extended through pulmonic valve into main artery its bifurcations, numerous bilateral lobar, segmental subsegmental emboli. Systemic anticoagulation heparin initiated. deemed not be candidate catheter based thrombolysis, owing position thrombus, neither open surgery, given late stage her malignancy. started morphine infusion relief pain, transitioned hospice shortly thereafter. DISCUSSION: In one study RV found about 4% cases embolism.[1] can classified various groups, depending shape mobility thrombus.[2] this demonstrate findings contiguous artery. There no guidelines little evidence best approach treatment thrombi. While thrombolysis is indicated patients massive embolism, utility without hemodynamic instability remains less clear. Catheter challenging, our patient, if anatomy that it precludes adequate placement catheter. CONCLUSIONS: The diagnosis management challenging; further studies warranted. REFERENCE #1: Casazza F, Becattini C, Guglielmelli E, et al. Prognostic significance free-floating thromboemboli acute embolism: results Italian Embolism Registry. Thromb Haemost. 2014 Jan;111(1):53-7. #2: Naeem K. Floating role echocardiography. Pak J Med Sci. 2015 Jan-Feb; 31(1): 233–235. DISCLOSURES: No relevant relationships by Dan Kazmierski, source=Web Response Si Li, jacob miller, Pius Ochieng, Dhaval Patel, NISHANT SHARMA,