Pulmonary embolism: Thrombus-in-transit

Background

Point-of-care transthoracic echocardiography can be useful in diagnosing a pulmonary embolism in patients with hemodynamic instability and facilitate with their management in the emergency department.

Case report

A 64 year-old man presented to the ED with several days of worsening exertional dyspnea associated with left-sided chest pain who was hemodynamically unstable. Point-of-care ultrasound revealed a clot in the right atrium, which led to further assessment of the right heart function to detect signs of acute right heart strain when a pulmonary embolism is highly suspected.

Why should an emergency physician be aware of this?

Point-of-care ultrasound (POCUS) was utilized to evaluate characteristic findings that will predict a higher risk of deterioration from a pulmonary embolism. Rarely, a mobile clot can be seen within the right atrium which is highly specific for imminent pulmonary embolism and is associated with higher risk of decompensation. Bedside transthoracic echocardiogram allowed for rapid diagnostic assessment that guided decision making and early management of pulmonary embolism, which can improve the patient's outcome.