[Fibrinolysis in right ventricular thrombus]

Area of Science:

• Cardiology
• Vascular Surgery
• Critical Care Medicine

Background:

• Deep vein thrombosis (DVT) and pulmonary embolism (PE) can arise from various causes, including trauma.
• Right ventricular thrombosis is a rare but serious complication, often associated with DVT and PE.
• Echocardiography is crucial for diagnosing intracardiac masses and assessing their impact on cardiac function.

Observation:

• A 34-year-old male presented with DVT and PE following toe fractures.
• Echocardiography revealed a large (4.5 cm x 3.5 cm) mobile mass in the right ventricle, suspected to be a thrombus.
• Despite heparin therapy, the patient's condition worsened, necessitating fibrinolytic treatment with streptokinase.

Findings:

• Fibrinolytic therapy initially improved pulmonary gas exchange but was followed by progressive cardiopulmonary insufficiency and death.
• Necropsy confirmed a right ventricular thrombus, smaller than visualized on echocardiography, with surface erosions from fibrinolysis.
• Pulmonary vessels showed multiple fragmented emboli, indicating a potential fragmentation of the right ventricular thrombus.

Implications:

• This case highlights the potential risks of fibrinolytic therapy in managing right ventricular thrombosis.
• Fibrinolysis may lead to dangerous fragmentation of the thrombus, causing lethal pulmonary emboli.
• Surgical thrombectomy might be a safer alternative to fibrinolysis for right ventricular thrombosis, especially in severe cases.