Right heart free-floating thrombus in a pregnant woman with massive pulmonary embolism: a case of 'emboli in transit'.

ABSTRACT

The mainstay of treatment for massive pulmonary embolism in nonpregnant individuals is urgent thrombolytic therapy, but experience with these drugs in pregnancy is limited. We report a case of a 36-year-old woman at 27 weeks' gestation who was admitted with a massive, life-threatening pulmonary embolism. The diagnosis was rapidly accomplished in the coronary care unit by transthoracic echocardiography that showed signs of pulmonary hypertension as well as a large, free-floating thrombus in the right heart. As she was hemodynamically unstable, we started treatment with tissue plasminogen activator resulting in complete resolution of cardiorespiratory symptoms. A live baby was delivered by Caesarean section at 37 weeks of gestation, and no complications were seen during the 1-year follow-up. The present case report emphasizes the pivotal role of repeat echocardiography in clinical decision-making and the life-saving potential of thrombolytic therapy without serious adverse effects.