Enbiya AKSAKAL, Mücahit EMET, Hüsnü DEĞİRMENCİ, Mustafa UZKESER

Pulmoner Emboliye Neden Olan Yılanvari Sağ Atrial Trombüs Olgusu

Sağ atriyal trombüs nadirdir fakat yaklaşık %30-40 ölüme neden olabilmektedir. Ekokardiyografi pulmoner embolinin kardiyak kökenli nedenlerinin belirlenmesinde önemlidir ve hareketli trombüs nadiren aynı anda sağ atriyum ve pulmoner arterde görüntülenebilir. Trombolitik tedavi sağ atriyal trombüs ve masif pulmoner emboli olan hastalarda hayat kurtarıcı girişimdir. Biz bu yazıda interatriyal septuma tutunan ve pulmoner emboliye yol açan yılanvari sağ atriyal trombüs olgusunu sunmayı amaçladık. Bu olgunun ilginç olan özelliği, hareketli trombüsler transtorasik ekokardiyografi ile sağ atriyum ve pulmoner arterde aynı anda görüntülenmiştir

Anahtar Kelimeler:

Sağ atriyal trombüs, pulmoner emboli, trombolitik tedavi

A Case of a Serpentine-like Right Atrial Thrombus Causing Pulmonary Embolism

Right atrial thrombi are rare but cause mortality in approximately 30-40% of cases. Echocardiography is important for determining the causes of the cardiac origin of pulmonary embolism, and, simultaneously, mobile thrombi can be rarely visualized in the right atrium and pulmonary artery. Thrombolytic therapy is a life-saving intervention in patients with a right atrial thrombus and massive pulmonary embolism. In this report, we present a case of a serpentine-like right atrial thrombus adhered to the interatrial septum, leading to pulmonary embolism. The interesting feature of this case is that mobile thrombi were simultaneously visualized in the right atrium and pulmonary artery by transthoracic echocardiography

Keywords:

Right atrial thrombus, pulmonary embolism, thrombolytic theraphy,

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Torbiki A, Galie N, Covezzoli A, Rossi E, Goldhaber S. Right heart thrombi in pulmonary embolism: results from the International Cooperative Pul- monary Embolism Registry. J Am Coll Cardiol 2003; 41: 2245-51.
Chartier L, Béra J, Delomez M, Asseman P, Beregi JP, Bouchart JJ, et al. Fre- efloating thrombi in the right heart: diagnosis, management, and prog- nostic indexes in 38 consecutive patients. Circulation 1999; 99: 2779-83. [CrossRef]
Covarrabias EA, Shekh MU, Fox LM. Echocardiography and pulmonary embolism. Ann Intern Med 1977; 87: 720-1.
Kinney EL, Wright RJ. Efficacy of treatment of patients with echocardiog- raphically detected right-sided heart thrombi: a meta-analysis. Am Heart J 1989; 118: 569-73. [CrossRef]
Moser KM. Pulmonary thromboembolism, in Harison’s Principles Of In- ternal Medicine, 12 th edition. Wilson JD, Braunwald E, Isselbacher KJ, Pe- tersdorf RG, Martin JB, Fauci AS, Root RK, New York, McGraw- Hill 1991, pp 1090-6.
Erkut B, Koçak H, Becit B, Şenocak H. Massive pulmonary embolism complicated by a patent foramen ovale with stradding thrombus: report of case. Surgery Today 2006; 36: 528-33. [CrossRef]
Huang SL, Chien CH, Chang YC. A floating thrombus of the right ventricle in severe massive pulmonary embolism. Am J Emerg Med 2008; 26: 1071. e1-2.
Fabijanić D, Rudež I, Radić M, Unić D, Barić D, Kardum D. Pulmonary em- bolism due to the right atrial thrombus mimicking atrial myxoma. Chin Med J 2010; 123: 2483-5.
Hohn A, Trojan S, Poels M, Sakka SG, Wappler F. Fulminant pulmonary ar- tery embolism in the early postoperative phase. Use of transesophage- al echocardiography in acute diagnostics. Anaesthesist 2010; 59: 812-7. [CrossRef]
Soydinç S, Davutoğlu V, Yıldırım C, Ünay N, Küçükdurmaz Z. Ekokardiyog- rafiyle saptanan mobil sağ ventrikül trombüsü ve trombolitik ajanla başa- rılı tedavi edilen masif pulmoner emboli olgusu. Turk J Emerg Med 2004; 4: 78-80.
Yilmaz M, Beyan E, Uçar O, Koşan B, Arduç A, Abayli E. A case of acute pulmonary thromboembolism with a mobile thrombus in right ventricle detected with echocardiography. Anadolu Kardiyol Derg 2008; 8: E34.
Kearon C, Kahn SR, Agnelli G, Goldhaber S, Raskob GE, Comerota AJ, et al. Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th edn). Chest 2008; 133: 454S-545S.
Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galiè N, Pruszczyk P, et al. Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J 2008; 29: 2276-315. [CrossRef]
Cracowski JL, Tremel F, Baguet JP, Mallion JM. Thrombolysis of mobile right atrial thrombi following severe pulmonary embolism. Clin Cardiol 1999; 22: 151-4. [CrossRef]
Chartier L, Béra J, Delomez M, Asseman P, Beregi JP, Bauchart JJ, et al. Free-floating thrombi in the right heart: diagnosis, management, and prognostic indexes in 38 consecutive patients. Circulation 1999; 99: 2779-83. [CrossRef]
Saura D, García-Puente J, Oliva MJ, Cerdán MC, Gutiérrez F, de la Morena G, et al. Treatment of right heart thromboemboli: the need of a randomi- zed multicentre trial. Int J Cardiol 2009; 134: 419-20. [CrossRef]
Tsarouhas K, Kafantaris I, Antonakopoulos A, Limberopoulos G, Kouzani- dis I, Vavetsi S, et al. Free floating thrombus in the right atrium causing massive pulmonary embolism. Int J Cardiol 2010; 138: e21-3. [CrossRef]