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case_images: Two-dimensional transthoracic echocardiography reveals multiple thrombi in the right cavities (A):parasternal short axis view showing one thrombus in the right atrium close to the septal leaflet of the tricuspid valve and one thrombus in the right ventricle attached to the lateral region of the tricuspid annulus (arrow):(B) apical four-chamber view showing the thrombus at the level of the free wall of the right ventricle (arrow).
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case_images: A transthoracic echocardiogram (TTE) confirmed the diagnosis of multiple endocavitary thrombi: the largest one of 41 x 16 mm located at the level of the free wall of the right ventricular attached to the lateral region of the tricuspid annulus, one at the level of the right ventricular apex, and one of 18 x 14 mm in the right atrium close to the septal leaflet of the tricuspid valve (Figure 1 and Supplementary material online, Video S1).
case_images: Cardiac magnetic resonance image showing right intraventricular thrombus.
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case_images: A cardiac magnetic resonance imaging (MRI) was performed 7 days later and confirmed the presence of two large thrombi:one of 16 x 13 mm in the right atrium and one of 34 x 11 mm attached to the lateral trabeculations of the right ventricle (Figure 2 and Supplementary material online, Videos S2 and S3).
case_images: Apical four-chamber view in transthoracic echocardiography indicating (A) hypertrabeculation of the right ventricle (arrow), a high insertion of the posterior leaflet of the tricuspid valve ( arrow), a dilated right atrium:(B) moderate tricuspid regurgitation.
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case_images: TTE demonstrating an obvious decrease in the size of the two thrombi, hypertrabeculation of the right ventricle and a high insertion of the posterior leaflet of the tricuspid valve inducing a moderate tricuspid insufficiency mimicking an Ebstein disease (ED) (Figure 3). The LVEF had returned to normal.
case_images: (A) Delayed gadolinium enhancement cardiac MRI of short axis view shows subendocardial hyper-enhancement of the right ventricle suggesting fibrosis (arrows):(B) delayed gadolinium enhancement cardiac MRI shows discrete left lateral subepicardial hyper-enhancement suggesting a sequela of myocarditis.
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case_images: A new cardiac MRI showed in comparison with the previous examination: a nearly complete resolution of the cardiac thrombi, new onset of subendocardial delayed-enhancement of the right ventricle suggesting myocardial fibrosis and an improvement of the LVEF (50%) (Figure 4).