Qaem Cardiovascular Medical and Research Center, Mashhad Universityof Medical Sciences, Mashhad, Iran
Nonvalvular atrial fibrillation (AF) can affect both right and left atria. Left atrial thrombus is more common in patients with nonvalvular AF. The presence of a large right atrial thrombus is a rare condition, which is seldom demonstrated as an etiology ofpulmonary embolism, especially without any deep vein thrombosis at the presence of only atrial fibrillation, as was observed in this case. Right atrial thrombus is an underdiagnosed entitywith a high mortality and morbidity rate. Therefore, right atrial appendage (RAA) and left atrial appendage assessmentsshould be consideredin patients with chronic nonvalvular AF.The best management modality has not yet been documented, and it sometimes resolved by anticoagulant therapy alone or neededsurgical removal. Here, we report a case of pulmonary thromboembolism with the complaints of coughing and blood-stained sputumwithout clinical or sonographic signs of deep vein thrombosis. Permanent AF rhythm and a large clot in RAA were detected as the sources for pulmonary embolism. We started anticoagulant therapy and the clot got smaller using a transesophageal echocardiogram as a diagnostic tool.