Optimal Strategy for Diagnosis and Treatment of Pulmonary Embolism Due to Right Atrial Thrombus  Samuel Z. Goldhaber, M.D.  Mayo Clinic Proceedings  Volume 63, Issue 12, Pages 1261-1264 (December 1988) DOI: 10.1016/S0025-6196(12)65416-0 Copyright © 1988 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 1 Apical four-chamber echocardiographic view, showing dilated right ventricular and right atrial chambers with abnormal ventricular septal curvature consistent with right ventricular pressure or volume overload. Note large thrombus in right atrium (arrows) before treatment with urokinase (left panel); after administration of urokinase, resolution of right atrial thrombus is evident (right panel). LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle. (From Goldhaber and associates.1 By permission of The C. V. Mosby Company.) Mayo Clinic Proceedings 1988 63, 1261-1264DOI: (10.1016/S0025-6196(12)65416-0) Copyright © 1988 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 2 Lung scans of same patient as depicted in Figure 1. A, Initial scan demonstrates multiple segmental perfusion defects (arrows) involving right middle lobe (right lateral view), base of right lower lobe (right posterior oblique view), anterobasal left lower lobe (left posterior oblique view), and lingula (left lateral view). The ventilation images were normal, an indication that the perfusion defects are “mismatched,” consistent with a high probability of pulmonary emboli. B, Follow-up perfusion lung scan demonstrates substantial improvement in pulmonary perfusion, consistent with resolving pulmonary emboli. (From Goldhaber and associates.1 By permission of The C. V. Mosby Company.) Mayo Clinic Proceedings 1988 63, 1261-1264DOI: (10.1016/S0025-6196(12)65416-0) Copyright © 1988 Mayo Foundation for Medical Education and Research Terms and Conditions