Flanagan Leah, DuPlooy Petrus, Judge Gillian, McDermott Cian
Emergency Medicine, Mater Misericordiae University Hospital, Dublin, IRL.
Cureus. 2024 Sep 10;16(9):e69109. doi: 10.7759/cureus.69109. eCollection 2024 Sep.
A 32-year-old Asian male presented to the ED with a one-day history of mild pleuritic chest pain. He was diagnosed with an acute pulmonary embolus on CT Pulmonary Angiography (CT-PA). Transthoracic echocardiography (TTE) performed at the bedside in the ED demonstrated evidence of right heart strain but, most notably, a highly mobile echogenic thrombus in the right atrium, consistent with a clot-in-transit (CIT). This was not visualized on CT due to the influx of contrast in the heart. Based on this, the patient was transferred to the High Dependency Unit for IV heparin and close monitoring. The following day, he underwent clot retrieval using an Inari Flowtriever under direct TTE guidance. He was discharged on oral anticoagulation four days later and experienced no complications on follow-up. CIT is an important feature of pulmonary embolus to identify, as it can escalate the risk stratification of the patient, and management will need to be altered accordingly.
一名32岁的亚洲男性因轻度胸膜炎性胸痛一天就诊于急诊科。他在胸部CT血管造影（CT-PA）检查中被诊断为急性肺栓塞。在急诊科床边进行的经胸超声心动图（TTE）显示有右心劳损的迹象，但最值得注意的是，右心房内有一个高度活动的强回声血栓，符合移行性血栓（CIT）。由于心脏内造影剂的流入，CT上未显示该血栓。基于此，患者被转至高依赖病房接受静脉注射肝素并密切监测。第二天，他在直接TTE引导下使用Inari Flowtriever进行了血栓清除。四天后，他出院并接受口服抗凝治疗，随访期间未出现并发症。CIT是肺栓塞需要识别的一个重要特征，因为它会提高患者的风险分层，治疗也需要相应改变。
