A rare case of deep vein and right atrial thrombosis in a patient with chronic heart failure and pulmonary embolism

Deep vein thrombosis (DVT) is frequently observed in patients with chronic heart failure (CHF), increasing the risk of pulmonary embolism (PE). Clinical evaluation of CHF patients with suspected acute PE is challenging since these diseases share several symptoms and signs such as dyspnea. Thus, it is intuitive that correct and fast diagnosis of PE in these patients might be able to significantly change their clinical outcome. In the present report, we describe a rare case of a patient with CHF and PE due to a huge thrombosis of deep veins and of right atrium in whom echo evaluation permitted the correct diagnosis and therapy. [1,2]. This variability might be due to the different sensitivity of diagnostic criteria in reports: those hospitals, in which the screening for DVT is more accurate, are likely to find more cases of DVT and pulmonary embolism (PE) [3]. Myocardial infarction and heart failure increase the risk of PE. Conversely, patients with DVT have an increased risk of developing myocardial infarction and stroke [4]. Thus, a correct and fast diagnosis of PE in these patients plays a pivotal role to change their clinical outcome. In the present report, we describe the case of a patient with CHF complicated by PE due to a huge venous thrombosis that extended from pheripheral vein till the right atrium, where echocardiographic evaluation showed a rare image of thrombus floating in the cavity of cardiac chamber.