Free floating thrombus in right atrium and pulmonary thromboembolism

The authors describe a case of a patient with inoperable bladder cancer, who was admitted with syncope and arterial hypotension. After examination, an echocardiogram was requested, which showed a free-floating thrombus in the right atrium and dilatation of the right chambers. A diagnosis of pulmonary embolism was made, and heparin was started. The patient's clinical status worsened, with development of severe pulmonary hypertension due to the presence of large thrombi in the right and left pulmonary arteries. Despite a recent hemorrhagic event related to the bladder cancer, thrombolytic therapy was begun with improvement of the patient. The final echocardiogram was almost normal, without pulmonary hypertension and no dilatation of the right chambers.