Although the existing guidelines do not offer a clear statement for the management of thrombus in the right heart, it is associated with worse outcomes in patients with acute massive pulmonary embolism (PE). Thrombolytic therapy has not been convincingly shown to improve mortality or reduce the frequency of recurrent thromboembolism. Therefore, thrombolysis should be considered on a case-by-case basis when the benefits are assessed by the clinician to outweigh the risk of hemorrhage. While thrombi-in-transit in the right heart increases the rate of morbidity and mortality in patients with acute massive PE, thrombolytic therapy may lead to completely recovery of thrombus in these patients. We present here a rare case of 71 years-old woman presented with acute massive PE due to thrombi-in-transit in the right heart.
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