Currently, the only widely accepted indication for interventional
treatment in cases of pulmonary embolism is hemodynamic instability or
cardiogenic shock. However, the presence of a right-heart thrombus along
with a pulmonary embolism is a poor prognostic indicator, and
catheter-directed thrombolysis with the use of thrombolytic agents
should also be considered in this circumstance. Optimal management of
right heart thrombus and high-risk pulmonary embolism is still
uncertain. Herein, we present the case of an 81-year-old woman who
presented at our hospital after progressive dyspnea and a syncopal
event. The transthoracic echocardiography showed massive bilateral
pulmonary, right ventricular, and mobile atrial thrombus and also
right-sided enlargement. The patient was successfully treated with
acoustic pulse thrombolysis using the EKOS EkoSonic system and
echocardiography revealed complete resolution of her right-heart
thrombus and her high-risk pulmonary embolism 2 days later.