Idiopathic Clot in Transit in a Patient with Newly Diagnosed Cancer: A Case Report

Abstract

Background: In the absence of structural heart disease or atrial fibrillation, the presence of a free-floating thrombus in the right heart is quite uncommon. The echogenic material observed on ultrasound within the right atrium or ventricle is referred to as a "clot in transit." When this thrombus migrates from the heart to the lungs, it can lead to cardiopulmonary collapse, with symptoms ranging from mild respiratory distress to sudden death. Notably, there are case reports of patients harboring large thrombi who remained asymptomatic Case: This case involves a 48-year-old woman who presented with chest pain, shortness of breath, and lightheadedness following the initiation of chemotherapy for her recently diagnosed peripheral T-cell lymphoma affecting the axillary lymph nodes. During an echocardiogram performed to assess cardiac function amidst her chemotherapy sessions, a large, spherical right atrial thrombus was detected. Additionally, a right-to-left 3 mm patent foramen ovale (PFO) shunt was identified. To further evaluate the thrombus, a comprehensive workup was conducted, including a CTA of the chest, abdomen, and pelvis, alongside 2D echocardiography and transesophageal echocardiography. The plan was to proceed with the removal of the right atrial thrombus, which measured 2.4 x 2.62 cm. Conclusion: The presentation of a clot in transit can vary significantly, with some patients exhibiting no symptoms at all. This underscores the critical importance of early diagnostic evaluation and timely intervention to mitigate the risk of sudden death. This case report emphasizes the need for vigilance in the assessment and management of right atrial thrombi, highlighting the essential role of prompt treatment in improving patient outcomes.