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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. 1Intensive Care Medicine 1, Hospital de Faro, Faro, Portugal
  2. 2Cardiology, Hospital de Faro, Faro, Portugal
  3. 3Internal 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}gmail.com

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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.

Figure 1

A highly mobile heterogeneous hyperechoic mass is seen in the …

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