Right heart transiting thrombi caused by endovenous sclerotherapy: the treatment is not consensual

Description

A 69-year-old woman without medical history, was admitted in our emergency department for acute respiratory distress. Two weeks prior to admission, she had undergone an endovenous foam sclerotherapy of a right saphenous branch with aetoxisclerol 2%. Afterwards, she complained of progressive dyspnoea and right thoracic pain. On arrival at the emergency department, the patient was noted to have cyanosis, a respiratory rate of 35 breaths/min and oxygen saturation of 90% despite high-flow face mask oxygen administration. Heart rate was 115 beats/min and blood pressure was 140/65 mm Hg. On physical examination, superficial thrombosis of a right saphenous branch was noted (figure 1). Laboratory studies demonstrated an elevation of markers of myocardial injuries and right ventricular dysfunction with a troponin I level of 1968 ng/L (reference value <16 ng/L) and brain natriuretic protein level of 541 ng/L (reference value <100 ng/L). Arterial blood gas showed the following: pH, 7.42; Po₂, 86 mm Hg; Pco₂, 37 mm Hg. ECG revealed sinus...

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