Ehab Sobhy, Tarek Alamaldine and Hilal Al Sabti
We report a case of a large mobile right-sided heart thrombus (2.8 cm × 2.7 cm) complicated with pulmonary embolism. We planned to give thrombolytic therapy with an alteplase infusion and to repeat the TTE, and if the thrombus remained, to go ahead with surgical embolectomy with exploration of the right chambers and removal of the thrombus. Surgical removal of the thrombus with pulmonary embolectomy has been validated, but as it is a high-risk intervention, we were advised to try treatment with thrombolytic therapy first. Thrombolytic therapy resulted in complete disappearance of the thrombus, as documented by TTE. The patient was discharged home on oral anticoagulation with regular follow-up in outpatient clinic and lifelong anticoagulation was advised, as she was diagnosed to have type III protein S deficiency.
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