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‘Popcorn thrombus’: a case of massive intracardiac thromboembolism
  1. Steven L Driver1,
  2. Hayan Jouni1,
  3. Robert B McCully2
  1. 1Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
  2. 2Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Steven L Driver, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Sdriver{at}

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Case presentation

A 75-year-old man was urgently referred for evaluation of a syncopal episode accompanied by head trauma and lacerations. Chest CT angiography showed bilateral pulmonary emboli (PE) along with right atrial and ventricular filling defects (figure 1A–C). Lower extremity ultrasound showed bilateral deep venous thromboses. An echocardiogram demonstrated severe right ventricular dysfunction with extensive ‘popcorn thromboemboli’ in the right atrium prolapsing into the right ventricle during atrial systole (figure 1D-1, E-1). Thrombolytic therapy was contraindicated due to recent head trauma. Despite his concerning presentation, the patient initially declined surgical intervention.

Figure 1

Chest CT angiography and transthoracic echocardiography contrasting findings on day 1 vs day 2. Chest CT angiography with intravenous contrast using pulmonary embolism protocol demonstrated extensive bilateral pulmonary emboli …

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  • SLD and HJ contributed equally to this submission.

  • Collaborators Brandon T Larsen; Harold M Burkhart; Robert D McBane.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Mayo Clinic IRB.

  • Provenance and peer review Not commissioned; internally peer reviewed.