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The dilemma in the management of haemodynamically stable pulmonary embolism with right heart thrombus
  1. Manoj P Rai,
  2. Khadar Herzallah,
  3. Ahmad Alratroot and
  4. Heather Laird-Fick
  1. Internal Medicine, Michigan State University, Lansing, Michigan, USA
  1. Correspondence to Dr Manoj P Rai, manojrai029{at}


Right ventricular thrombus (RVT) can be life-threatening, since it has the potential to embolise and cause saddle pulmonary embolism (PE). We present a patient who initially presented with haemodynamically stable PE with evidence of RVT on echocardiogram. She was placed on heparin drip; however, she later developed cardiac arrest and died due to embolisation of RVT to the pulmonary vasculature. Although management of haemodynamically stable PE in patients with RVT is still a matter of debate,1 given the outcome we suggest that thrombolysis or emergent embolectomy at the presentation, in this case, may have had a favourable outcome.

  • venous thromboembolism
  • interventional cardiology
  • haematology (incl blood transfusion)
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  • Contributors MPR is the main author who contributed to the case description and discussion. KH assisted with editing the manuscript and obtaining the images for submission. AA, and HL-F assisted the proofreading of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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