Floating Thrombi in The Right Ventricular Outflow Tract

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A 51-year-old woman was admitted to the hospital for an intermittent syncope. No abnormal findings on physical examination. Laboratory results showed B-type brain natriuretic peptide of 1044.0 pg/ml (reference range, < 100), D-Dimer of 5.69 mg/L (reference range, < 0.5), FDP of 19.0 ug/ml (reference range, < 5), and blood NT-proBNP of 2580.0 pg/ml (reference range, < 125). Electrocardiogram demonstrated sinus rhythm, left axis deviation, and abnormal T-wave.

Health & Medicine

Annals of Clinical and Medical
Case Reports
Clinical Image ISSN: 2639-8109 Volume 8
Floating Thrombi in The Right Ventricular Outflow Tract
Na Li 1,2
, Osamah Alwalid1,2
and Heshui Shi1,2
*
1
Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang
Avenue, Wuhan, Hubei Province 430022, The People’s Republic of China.
2
Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, The People’s Republic of China
*
Corresponding author:
Heshui Shi,
Department of Radiology,Union Hospital, Tongji
Medical College, Huazhong University of Science
and Technology, Wuhan 430022, Hubei Province,
China, E-mail: heshuishi@hust.edu.cn
Received: 10 Dec 2021
Accepted: 21 Dec 2021
Published: 27 Dec 2021
J Short Name: ACMCR
Copyright:
©2021 Heshui Shi. This is an open access article distrib-
uted under the terms of the Creative Commons Attribution
License, which permits unrestricted use, distribution, and
build upon your work non-commercially.
Citation:
Heshui Shi, Floating Thrombi in The Right Ventricular
Outflow Tract. Ann Clin Med Case Rep. 2021; V8(4): 1-1
1. Clinical Image
A 51-year-old woman was admitted to the hospital for an intermit-
tent syncope. No abnormal findings on physical examination. Lab-
oratory results showed B-type brain natriuretic peptide of 1044.0
pg/ml (reference range, < 100), D-Dimer of 5.69 mg/L (reference
range, < 0.5), FDP of 19.0 ug/ml (reference range, < 5), and blood
NT-proBNP of 2580.0 pg/ml (reference range, < 125). Electrocar-
diogram demonstrated sinus rhythm, left axis deviation, and ab-
normal T-wave.
Echocardiography showed a streak-like echo in the right ventricle
and right ventricular outflow tract (RVOT) with widened pulmo-
nary artery and severe pulmonary hypertension. Deep venous ul-
trasound of both lower extremities revealed left superficial femoral
vein, posterior radial vein, peroneal vein and intermuscular veins
thrombosis. Cardiac magnetic resonance imaging cine sequence
revealed two long linear hypointense structures within the RVOT
(arrow; A) that moved in synchrony with the cardiac motion (see
video). Meanwhile, multiple bilateral pulmonary artery thrumbi
were seen on CMR. Three days later, computed tomographic pul-
monary angiography (CTPA) revealed multiple bilateral pulmo-
nary artery emboli (arrows; B), but no abnormal density was seen
in the RVOT (C). On repeated echocardiography, no abnormal
echo was seen in the RVOT. Therefore, it was highly likely that
the floating thrombi in the RVOT were dissolved due to anticoag-
ulation therapy throughout her hospitalization.
The patient was discharged with improved symptoms after antico-
agulation therapy. After one month of Rivaroxaban tablets use, the
pulmonary thrombi have reduced in size.
Figure: Floating thrombi in the RVOT. (A) Cardiac magnetic resonance imaging cine sequence shows two long linear hypointense structures within
the RVOT (arrow) that moved in synchrony with the cardiac motion (video). (B,C) CT pulmonary angiography shows bilateral pulmonary artery emboli
(arrows), but no abnormal density is seen in the RVOT.
http://acmcasereports.com 1

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