A 64-year-old hypertensive man undergoing treatment with cisplatin for gastric adenocarcinoma presented to the emergencies with syncope. Blood pressure was recorded at 126/78mmHg, heart rate at 108 bpm, and an S1Q3T3 pattern was noted. The echocardiogram revealed the presence of a dilated right ventricle with a mobile mass in the right atrium and a lesion straddling the pulmonary trunk bifurcation. An angio-CT identified a 10mm thrombus in the right pulmonary artery branch (Fig. 1-A) and an elongated 35mm thrombus in the left branch (Fig. 1-B). After 24hours, an elongated 11cm thrombus (Fig. 2-arrow) was detected in transit through the interatrial septum (Fig. 2-asterisk). Surgical intervention was ultimately decided upon, and a pulmonary and cardiac thrombectomy followed by the closure of the patent foramen ovale were performed.

Figure 1

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Figure 2

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