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Right sided heart thrombi may develop within the right heart chambers or they may be peripheral venous clots that, on their way to the lungs, accidentally lodge in a patent foramen ovale, tricuspid chordae or Chiari’s network. Type A thrombi have a worm-like shape and are extremely mobile.1 These pleomorphic thrombi are mainly localised to the right atrium, frequently move back and forth through the tricuspid orifice, and may cause cardiovascular collapse when entrapment occurs.2 Type B thrombi attach to the atrial or ventricle wall indicating that they are probably of local origin.
Right sided deep vein thrombosis evolved three days after left heart catheterisation in a 27 year old woman with severe peripartum cardiomyopathy (ejection fraction < 30%). Acute orthopnoea four days later with severe hypotension (80/40 mm Hg) and tachycardia (132 beats/min) necessitating mechanical ventilation was highly suggestive of massive pulmonary embolism. Abdominal ultrasonography revealed a …