Right atrial mobile thrombi: two-dimensional echocardiographic diagnosis and clinical outcome.

Four patients with pulmonary embolism and right atrial mobile thrombi (RAMT) are described. One patient died during intravenous heparin treatment because of a "saddle" pulmonary artery embolus, another died from surgical complications after successful embolectomy. One of the two survivors was treated with intravenous streptokinase and the other with intravenous heparin. Echocardiographically detected RAMT seems a reliable sign of impending massive pulmonary embolism. Pulmonary angiography is unnecessary and may be dangerous. Surgical removal of RAMT, fibrinolytic treatment or intravenous heparin introduced promptly may be lifesaving.