Summary

We present the case of a middle-aged man who was admitted with progressive shortness of breath and haemodynamic instability. He was diagnosed as having unprovoked bilateral central pulmonary emboli. Thrombolysis with alteplase was provided. Subsequently, an echocardiogram was performed which showed a thrombus straddling the interatrial septum. This was managed conservatively with enoxaparin anticoagulation. A repeat echocardiogram 2 days later showed complete resolution of the thrombus without clinical systemic arterial thromboembolic sequelae such as stroke, myocardial ischaemia or acute limb ischaemia.