Vuille C, Urban P, Jolliet P, Louis M
Centre de cardiologie, Hôpital cantonal universitaire, Genève.
Schweiz Med Wochenschr. 1993 Oct 16;123(41):1945-50.
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.
右心房血栓的存在是肺栓塞患者高死亡率的一个公认预测因素。在本报告中，我们描述了两例经超声心动图证实右心房存在游离血栓的病例；两例患者在溶栓治疗后血栓均迅速溶解，临床症状迅速改善，预后良好。在肺栓塞急性期，超声心动图可检测到右心室扩张、肺动脉扩张、左心室较小以及室间隔矛盾运动。在大面积肺栓塞病例或诊断存在疑问时，这种非侵入性方法有助于指导诊断和治疗决策。在通过超声心动图检测到右心房血栓的特殊情况下，溶栓治疗似乎是必要的。
