# Right Ventricular Thrombus Presenting With Right Ventricular Failure in Septic Shock: A Case Report

## TL;DR

A patient with septic shock developed right ventricular failure and a thrombus, requiring complex clinical decisions when imaging was not possible.

## Contribution

Highlights clinical decision-making in shock when contrast imaging is contraindicated.

## Key findings

- Echocardiography identified right ventricular failure and thrombus in a patient with septic shock.
- Pulmonary embolism was suspected but could not be confirmed due to contraindications for contrast imaging.
- Anticoagulation was used, but mechanical thrombectomy was not feasible due to progressive renal failure.

## Abstract

We present a case report of refractory multifactorial shock initially managed as septic shock, requiring multidisciplinary collaboration when the diagnostic pathway was limited by acute kidney injury; the primary learning objective is to highlight clinical decision-making in shock when standard contrast imaging is contraindicated. Echocardiography revealed right ventricular failure with right ventricular thrombus, and pulmonary embolism was strongly suspected but could not be confirmed due to the inability to obtain contrast imaging. Persistent shock prompted a transition from a septic shock-directed strategy to cardiogenic and obstructive shock management. The patient was treated with anticoagulation but was not a candidate for mechanical thrombectomy. The course was complicated by progressive renal failure, and after dialysis was declined by the family, the patient was transitioned to comfort care.