Right atrial thrombus in a patient with COVID-19 pneumonia: a case report

• Published in: European heart journal. Case reports Vol. 4; pp. 1 - 4
• Main Authors: Shamsah, Mohammed A, Bitar, Zouheir Ibrahim, Alfoudri, Huda
• Format: Report
• Language: English
• Published: 01.10.2020
• ISSN: 2514-2119
• DOI: 10.1093/ehjcr/ytaa296

BACKGROUNDSignificant coagulopathy and hyperinflammation are found in patients with coronavirus disease 2019 (COVID-19). Expert consensus has recommended prophylactic anticoagulation in COVID-19 patients due to the risk of thrombo-embolism. However, the use of therapeutic anticoagulation in these patients is still a matter of debate. CASE SUMMARYWe describe a patient with COVID-19 pneumonia and a clinical hyperinflammatory state. He developed early respiratory depression and required ventilation, and he subsequently developed haemodynamic instability. Point-of-care echocardiography demonstrated a right atrial thrombus and right ventricular dysfunction suggestive of acute massive pulmonary embolism. He was managed with veno-arterial extracorporeal membrane oxygenation and local thrombolysis. DISCUSSIONCritical cases of COVID-19 pneumonia are associated with hypercoagulation, and these patients should be monitored closely for complications. Therapeutic anticoagulation may play a role in the management and prevention of thrombo-embolism.