Pinball-like free-floating right heart thrombus presenting as unexplained hypoxemia

Pinball-like free-floating right heart thrombus presenting as unexplained hypoxemia

Free-floating right heart thrombus is a rare and life-threatening condition associated with pulmonary embolism, for which there are no established guidelines for management. This report describes a case of a 67-year-old woman awaiting orthopedic surgery who presented with unexplained hypoxemia. Transthoracic echocardiography revealed multiple mobile masses in the inferior vena cava, right atrium, and right ventricle. The patient collapsed during the procedure but was successfully resuscitated. Subsequent chest computed tomography angiography showed extensive pulmonary thromboembolisms. The patient received thrombolytic treatment resulting in gradual improvement, but did not regain consciousness due to hypoxic brain damage. Patient with risk factors for thrombus formation, including orthopedic surgery, a free-floating right heart thrombus is suspected as the cause of unexplained hypoxemia, possibly due to pulmonary thromboembolism. Timely and appropriate treatment is crucial to improve the prognosis and prevent fatal disease complications in high risk patient.