Thrombus in transit associated with fatal pulmonary thromboembolism in an elderly Ethiopian man following a surgical procedure: A case report

A thrombus in transit refers to a thrombus that is temporarily lodged in the right-side chambers of the heart with a high risk of embolization to the pulmonary artery. A 75-year-old man presented to the emergency department with a sudden onset of retrosternal chest pain for an hour associated with shortness of breath, which developed a week after transurethral resection of the prostate was done for the indication of benign prostatic hyperplasia. The physical examination was remarkable for tachycardia, tachypnea, hypoxia, and raised jugular venous pressure. Echocardiography revealed a serpiginous echogenic density in the right atrium, protruding through the tricuspid valve and extending to the right ventricle. He was put on facemask oxygen, and he received anticoagulation with unfractionated heparin, followed by thrombolytic therapy with streptokinase. However, the patient experienced cardiac arrest during the administration of thrombolytic therapy, and he died despite all the efforts, most likely due to a massive pulmonary thromboembolism resulting from the thrombus in transit. This case report has brought attention to the rare occurrence of a thrombus in transit complicated by fatal pulmonary thromboembolism. It has also highlighted the significant mortality risk that this condition carries, even with thrombolytic therapy.