Trajectory Based Management of Right Heart Thrombus in Acute Pulmonary Embolism

Right heart thrombus in acute pulmonary embolism is an uncommon finding with immediate prognostic and therapeutic implications. This focused narrative review integrates haemodynamic status, right ventricular function, thrombus context, bleeding risk, treatment selection, and serial imaging. Particular emphasis is placed on the 2024 case series by Teterina and colleagues, which demonstrates clinically important heterogeneity in presentation, management, and follow-up trajectories. Registry evidence and contemporary European Society of Cardiology guidance are used to develop a trajectory-based framework for stabilization, phenotype-based treatment, reassessment, and longitudinal follow-up.