Right ventricular thrombus
Known metastatic TCC.
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A filling defect is demonstrated within the right ventricle and extends into the proximal pulmonary trunk. It is heterogeneous in shape but overall measures approximately 5 x 3 x 3 cm in size. Opacification of the pulmonary circulation is demonstrated distal to this, there is no convincing evidence of distal pulmonary embolism. The filling defect is visible on the portal venous scan of the abdomen, and thus does not represent poor mixing of opacified and unopacified blood. The right lower lobe pulmonary artery is almost entirely occluded just distal to its origin. A large pericardial effusion is present measuring 2.5 centimetres in depth, and prominent lymph nodes are seen at the hila, more so on the left. Nodules are demonstrated peripherally in the right lower lobe, with a pleural base. Small pleural effusion noted on the right. Otherwise the lungs and pleural spaces are unremarkable.
Filling defect extending from the right ventricle into the proximal pulmonary trunk suggests presence of thrombus (either bland or tumour). Echocardiography recommended.
Large pericardial effusion and mediastinal metastatic disease resulting in near-occlusion of the right lower lobe pulmonary artery.
The patient underwent an echo cardiogram which confirmed the presence of the thrombus. Unfortunately the patient discharged themselves against medical advice and has been lost to followup.