[Thrombosis of the right auricle in pulmonary embolism: value of echocardiography and indications for thrombolysis].

The presence of a right atrial thrombus is a recognized predictive factor of high mortality in patients with pulmonary embolism. In this report we describe two cases in which a free-floating thrombus in the right atrium was demonstrated by echocardiography; it resolved rapidly in both cases after thrombolytic therapy which resulted in a rapid clinical improvement and favorable outcome. During the acute phase of pulmonary embolism, a dilated right ventricle, a dilated pulmonary artery, a left ventricle of small size and paradoxical motion of the interventricular septum can be detected by echocardiography. In cases of massive pulmonary embolism or when there is doubt regarding the diagnosis, this noninvasive method serves to guide diagnostic and therapeutic decisions. In the special case where a right atrial thrombus is detected by echocardiography, thrombolytic therapy seems warranted.