Acute pulmonary embolism associated with left atrial intracavitary thrombosis – incidental imaging finding

Abstract

Background. Acute pulmonary embolism (APE) is a severe cardiovascular condition characterized by obstruction of pulmonary circulation by thrombotic material. In rare cases, it may be associated with intracavitary thrombi, such as those located in the left atrium, increasing the risk of complications. Objective(s). Clinical presentation of bilateral acute pulmonary embolism associated with a left atrial intracavitary thrombus, incidentally found in an elderly patient with pneumonia. Materials and methods. The case of a patient with moderate community-acquired pneumonia and associated chronic heart failure was evaluated. During antibiotic treatment, the patient experienced a clinical and paraclinical worsening (D-dimers 9.38 mg/l, CRP– 74.2mg/l, fibrinogen–7g/l), initially interpreted as a worsening of pneumonia in an elderly patient with comorbidities. Results. A 75-year-old male patient with chronic congestive heart failure, on the third day of hospitalization for pneumonia, developed pronounced dyspnea at rest, significant fatigue, and low-grade fever. Transthoracic echocardiography revealed an atrial septal defect (ASD) and a large, mobile thrombus measuring 8 cm in the left atrium, attached to the fossa ovalis, posing a high embolic risk. Pulmonary imaging showed new bilateral changes suggestive of pulmonary thromboembolism. The ASD was successfully corrected by minimally invasive catheterization, and histopathological analysis confirmed organized thrombotic masses. Conclusion(s). Atrial intracavitary thrombosis may be an incidental finding, especially in an elderly patient with ASD. A thorough assessment, including echocardiography, in a patient with pneumonia can support early diagnosis and effective management of acute pulmonary thromboembolism.