Thrombus-in-Transit: A Case for a Multidisciplinary Hospital-Based Pulmonary Embolism System of Care.

Academic Article


  • BACKGROUND: Venous thromboembolism, including pulmonary embolism (PE), is a common disease identified in the emergency department that carries significant morbidity and mortality. In its most severe form, PE is fulminant and characterized by cardiac arrest and death. CASE REPORT: In the midst of risk-stratifying PE by using echocardiography to assess right ventricular function, thrombus-in-transit (free-floating clot in the right atrium or ventricle) may be seen. We present a case of a 49-year-old man diagnosed with an acute saddle PE who was incidentally found to have a thrombus-in-transit and patent foramen ovale and required open thrombectomy. Identification of these additional potentially life-threatening features was possible only due to our availability of risk-stratification resources, specifically bedside echocardiography. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Albeit rare, with a reported incidence estimated at 4%, the presence of thrombus-in-transit may change emergent clinical management. A multidisciplinary team of resources should be considered emergently as part of a hospital-based PE system of care.
  • Authors

    Published In


  • outcome, pulmonary embolism, system of care, thrombus-in-transit, treatment, Echocardiography, Foramen Ovale, Patent, Humans, Incidental Findings, Male, Middle Aged, Point-of-Care Systems, Pulmonary Embolism, Treatment Outcome
  • Digital Object Identifier (doi)

    Author List

  • Pappas AJ; Knight SW; McLean KZ; Bork S; Kurz MC; Sawyer KN
  • Start Page

  • 298
  • End Page

  • 302
  • Volume

  • 51
  • Issue

  • 3