Beyond anticoagulation: a surgical rescue guided by multimodal imaging for mobile right heart thrombi in an adolescent

Abstract Right heart thrombus is rare and high-risk in paediatrics. A 14-year-old boy presented with dizziness and leg numbness. Imaging revealed mobile right ventricular thrombi and massive pulmonary embolism. Despite therapeutic anticoagulation, respiratory failure ensued. Emergency surgical thrombectomy and pulmonary endarterectomy were lifesaving. This case highlights that for high-risk right heart thrombi, multimodal imaging is key, and timely surgery is critical.