Right ventricular thrombus in case of atrial septal defect with massive pulmonary embolism: A diagnostic dilemma

Transthoracic echocardiogram showed dilated RA and right ventricle (RV), RV thrombus, moderate RV dysfunction, pulmonary hypertension (right ventricular systolic pressure [RVSP]-58 mm of Hg), no regional wall motion abnormalities, and normal left ventricular function. Intraoperative transesophageal echocardiography (TEE) mid-esophageal five chamber view showed a 2 cm x 3 cm mobile echogenic mass in the RV cavity [Figure 1] and Video 1], mid-esophageal RV inflow-outflow view [Figure 2] and Video 2], and transgastric RV outflow view [Figure 3] and Video 3] revealed mobile thrombus 2 cm x 2 cm in the right ventricular outflow tract attached below the pulmonary valve. Transgastric right ventricular short axis view showed a 2 cm x 3 cm echogenic mass in between the trabeculations of the RV [Figure 4] and Video 4], upper esophageal ascending aortic short axis view showed organized thrombus in right pulmonary artery (RPA) [Figure 5] and Video 5], mid-esophageal four chamber view showed dilated RA/RV, moderate RV dysfunction (tricuspid annular plane systolic excursion (TAPSE-11)), severe pulmonary hypertension (RVSP = 60 mm of Hg), and good left ventricular function.