A Prolapsing Right Heart Thrombus

A 95 year old female with history of hypertension presented with acute onset dyspnea at rest. Electrocardiography for this patient was suggestive of right bundle branch block. Echocardiogram showed large mobile free floating serpentine masses in right atrium. This was associated with the pathognomonic findings of an akinetic right ventricular (RV) free wall and hyper-contractile apex (McConnell sign) (Figures 1, 2 and 3, videos 1 and 2). Computed tomography revealed an acute pulmonary embolus (PE) in right and left pulmonary arteries as well as right atrial and ventricular dilation, and a renal mass, suggesting malignancy.