case_images: PMC5857334_01
case_images: Intraoperative 12 lead electrocardiogram demonstrating signs of acute cor pulmonale: S waves in lead 1 and Q waves with the suggestion of T wave inversion in lead 3.
case_images: CRIA2018-8709026.001.jpg
case_images: PMC5857334_01_CRIA2018-8709026.001.jpg
case_images: fig1
case_images: A 12-lead EKG showed signs of right heart strain, including an S wave in lead 1 and Q waves with T wave inversion in lead 3 (Figure 1). The apical four-chamber view revealed a mobile mass in the right atrium (RA) suspicious for a thrombus (Figure 2, Supplemental Video 1).
case_images: Intraoperative transthoracic echocardiography, 4 chamber apical view showing a right atrial thrombus (arrow), right ventricular dilatation, right atrial dilatation, and septal bowing. RV, right ventricle; RA, right atrium; IVS, interventricular septum; LA, left atrium; LV, left ventricle.
case_images: CRIA2018-8709026.002.jpg
case_images: PMC5857334_01_CRIA2018-8709026.002.jpg
case_images: fig2
case_images: The apical four-chamber view revealed a mobile mass in the right atrium (RA) suspicious for a thrombus (Figure 2, Supplemental Video 1). In the midesophageal 4-chamber view, a patent foramen ovale and associated RA thrombus were evident (Figure 3, Supplemental Video 2).
case_images: Initial intraoperative transesophageal echocardiography; midesophageal 4-chamber view. A large right atrial thrombus was visualized (blue arrow). LA, left atrium; RA, right atrium; RV, right ventricle.
case_images: CRIA2018-8709026.003.jpg
case_images: PMC5857334_01_CRIA2018-8709026.003.jpg
case_images: fig3
case_images: In the midesophageal 4-chamber view, a patent foramen ovale and associated RA thrombus were evident (Figure 3, Supplemental Video 2).
case_images: Perioperative chest computed tomography angiography; coronal reconstructions. (a) Filling defects were noted in right upper (red arrow) and lower lobar (green arrow) pulmonary arteries. (b) Right ventricular dilatation.
case_images: CRIA2018-8709026.004.jpg
case_images: PMC5857334_01_CRIA2018-8709026.004.jpg
case_images: fig4
case_images: CT angiography revealed RV dilatation with a large distal right PA thrombus extending into the upper and lower lobar arteries, along with a left upper and lower lobar artery thrombus (Figure 4).