Serpentine Thrombus of the Right Cavities of the Heart Extending to the Trunk of the Pulmonary Artery Complicating a Uterine Leiomyosarcoma without Pulmonary Embolism: Case Report

Abstract

Serpentine thrombus or snake like floating thrombus of the right-side cavities of the heart is a rare diagnosis. Its an extreme emergency, and is often fatal due to the migration of small thrombus which can completely obstruct the pulmonary trunk. Advanced cancer disease is one of the rare causes of this diagnosis. Two-dimensional transthoracic echocardiography helps to confirm the diagnosis while Angio CT-Scan confirms the presence of pulmonary embolism in patients presenting acute or aggravative dyspnea. Treatment may involve surgical thrombectomy or intravenous thrombolysis but the use of medical treatment alone (that is oral or subcutaneous injectable anticoagulants) has never been an effective choice of therapy except in exceptional cases. We report a rare case of a patient followed at the oncology department for locally advanced uterine leiomyosarcoma under chemotherapy who presented aggravating symptom of dyspnea at the emergency department where a serpentine thrombus was diagnosed by transthoracic echocardiography. Angio computed tomography scan (Angi-CT SCAN) showed no signs of pulmonary embolism in the patient who finally was placed on low molecular weight heparin (LMWH) due to high bleeding risk with a good outcome under strict hospital surveillance. This case reflects the difficulty of therapy strategies in some population of patients with high risk of mortality due to the presence of floating thrombus associated with high bleeding risk.