Right atrial thrombus migration during echocardiography: a case for urgent intervention

KEY WORDS: Cross-sectional echocardiography, right atrial thrombus, pulmonary embolism. A 65-year-old woman presented with increasing shortness of breath, chest pain and ST-T wave abnormalities on the electrocardiogram suggestive of unstable angina. Cross-sectional echocardiography performed to assess wall-motion abnormality and left ventricular function revealed a pedunculated right atrial thrombus prolapsing into the right ventricle which suddenly dislodged and migrated into the pulmonary circulation during the examination. A diagnosis of recurrent pulmonary thromboebolism was made, necessitating urgent pulmonary angiography with infusion of streptokinase. The patient made an uneventful recovery