right atrial appendage clot in atrial fibrillation complicated by pulmonary thromboembolism: a case report

Introduction: 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 of pulmonary 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 entity with a high mortality and morbidity rate. the best management modality has not yet been documented, and it sometimes resolved by anticoagulant therapy alone or needed surgical removal. case presentation: here, we report a case of pulmonary thromboembolism with the complaints of coughing and blood-stained sputum without 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. conclusions: right atrial appendage (raa) assessment should be considered in patients with recurrent or acute pulmonary embolism and af rhythm in the absence of clinical and sonographic signs of deep vein thrombosis.