Embolia pulmonar aguda associada a trombos em trânsito no coração direito: um dilema diagnóstico e terapêutico

Abstract

Acute pulmonary embolism (APE) is one of the main cardiovascular emergencies, characterized by obstruction of the pulmonary circulation by thrombi, typically originating from the deep venous system. Among its clinical presentations, APE associated with right-heart thrombi in transit (CIT) stands out as a rare and high-risk condition, marked by the presence of mobile thrombi within the right cardiac chambers with potential for massive embolization. The absence of standardized guidelines and the lack of randomized clinical trials make the management of this entity challenging, requiring the integration of clinical, laboratory, and imaging data. This study provides a narrative review of literature published between 2020 and 2025, aiming to analyze the main pathophysiological, diagnostic, and therapeutic aspects of APE with CIT. The analysis revealed significant methodological gaps and the absence of consensus regarding the superiority of the main therapeutic strategies—anticoagulation, thrombolysis, and embolectomy. The findings indicate that clinical decision-making relies more on hemodynamic severity and institutional resources than on the isolated technique employed. In conclusion, APE with CIT is a highly lethal and complex condition, whose prognosis is closely linked to timely diagnosis, institutional readiness, and the experience of the multidisciplinary team. Multicenter studies and the development of specific clinical protocols are essential to improve care quality and reduce mortality associated with this clinical presentation of APE.