Free floating thrombus in the right atrium causing massive pulmonary embolism

The movement of thrombi migrating from the veins of the lower limbs can give rise to pulmonary emboli within 24 hours. This is manifested as massive pulmonary embolism in 30% of cases, with a mortality rate of around 50%. Free-floating thrombi within the right cardiac cavities are rare, and the diagnosis is made mainly by transthoracic and transoesophageal echocardiography. Treatment includes surgery, invasive percutaneous embolectomy, thrombolysis and heparin administration. Here we report the case of an 80-years-old patient with massive pulmonary embolism caused by a free floating thrombus within the right atrium. Tenecteplase was administered with excellent results.