07 May 2026
: Case report 
Caught in Transit: Mobile Right Atrial Thrombus in Intermediate-High-Risk Pulmonary Embolism Treated With Half-Dose Alteplase
Unusual clinical course, Challenging differential diagnosis, Diagnostic / therapeutic accidents, Management of emergency care, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)
Wael Gomaa ABCDEF 1, Khaled Sewify ABCDEF 1*, Eslam Elsayed Abdelshafey ABCEF 1, Abdulaziz Alsaher D 1, Ragheb Elmessery CDEF 1, Fadah Alanazi CD 1, Adel Azmy D 2, Khalid Al Faraidy
D 2
DOI: 10.12659/AJCR.952646
Am J Case Rep 2026; 27:e952646
Table 2 Explicit risk-stratification inputs used to classify this presentation as intermediate-high-risk pulmonary embolism.
| Parameter | Finding at presentation |
|---|---|
| Hemodynamics | Normotensive (blood pressure preserved); heart rate 115 bpm |
| Oxygenation/respiratory status | Oxygen saturation 88% on room air; respiratory rate 30 breaths/min |
| sPESI score | 3 (chronic pulmonary disease [asthma], HR ≥110, oxygen saturation <90%) |
| Cardiac biomarkers | Troponin 0.39 ng/mL; BNP/NT-proBNP 1609 pg/mL |
| Perfusion marker | Lactate 2.5 mmol/L |
| Coagulation marker | D-dimer 1.07 mg/mL |
| Echocardiography (RV dysfunction) | RV dilation with pressure overload; TR Vmax 4.84 m/s (peak gradient 96.7 mmHg) |
| Echocardiography (clot-in-transit) | Mobile right atrial thrombus measuring 2.22×0.99 cm |
| CT pulmonary angiography | Multiple bilateral segmental and subsegmental filling defects consistent with acute pulmonary embolism |
| TR Vmax – tricuspid regurgitation maximum velocity; sPESI – simplified pulmonary embolism severity index; HR – heart rate; RV – right ventricle; CT – computed tomography. | |