RT Journal Article SR Electronic T1 Case of right ventricular and aortic thrombi in a patient with severe COVID-19 JF BMJ Case Reports JO BMJ Case Reports FD BMJ Publishing Group Ltd SP e240745 DO 10.1136/bcr-2020-240745 VO 14 IS 4 A1 Henrietta Afari A1 Leben Tefera A1 Rachel P Rosovsky YR 2021 UL http://casereports.bmj.com/content/14/4/e240745.abstract AB Emerging evidence suggests that novel COVID-19 is associated with increased prothrombotic state and risk of thromboembolic complications, particularly in severe disease. COVID-19 is known to predispose to both venous and arterial thrombotic disease. We describe a case of a 61-year-old woman with history of type II diabetes, hypertension and hyperlipidaemia who presented with dry cough and acute abdominal pain. She was found to have a significantly elevated D-dimer, prompting imaging that showed thrombi in her right ventricle and aorta. She had rapid clinical deterioration and eventually required tissue plasminogen activator with subsequent durable clinical improvement. This case highlights a rare co-occurrence of venous and arterial thrombi in a patient with severe COVID-19. Further studies are needed to clarify the molecular mechanism of COVID-19 coagulopathy, the utility of D-dimer to predict and stratify risk of thrombosis in COVID-19, and the use of fibrinolytic therapy in patients with COVID-19.