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Peeking at the right heart at the right moment: a giant thrombus in transit
  1. Miguel Lourenço Varela1,
  2. Teresa Mota2,
  3. Rita Martins Fernandes3,
  4. Francisco Soto1
  1. 1 Intensive Care Medicine 1, Hospital de Faro, Faro, Portugal
  2. 2 Cardiology, Hospital de Faro, Faro, Portugal
  3. 3 Internal Medicine, Hospital de Faro, Faro, Portugal
  1. Correspondence to Dr Miguel Lourenço Varela, Intensive Care Medicine 1, Hospital de Faro, Faro 8000-386, Portugal; miguelnvarela{at}

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A 46-year-old man, with acute-on-chronic hepatic failure and dilated cardiomyopathy, was admitted in the intermediate care unit after a sudden episode of dyspnoea without hypotension but with an elevated lactate of 3.9 mmol/L. He had an international normalised ratio of 3 and decreased factor V of 32.9%.

A bedside echocardiogram, while on sinus rhythm, revealed a mobile right atrial mass (figure 1A,B; see videos in supplementary material). Both ventricles were dilated with severely depressed function. No thrombi were present in a previous examination, 3 days before.

Supplementary video


Supplementary video


Figure 1

A highly mobile heterogeneous hyperechoic …

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  • Contributors MLV and TM performed the echocardiogram; MLV wrote the first draft; RMF, TM and FS revised the article and added content to it.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.