Right-Sided Septal Pouch Thrombus: An Unrecognized Source of Embolism

Ivy Ziqian Liu; Mohammad Alsheikh-Kassim; Jennifer K. Lang

doi:10.1016/j.jaccas.2025.105285

Right-Sided Septal Pouch Thrombus: An Unrecognized Source of Embolism

Ivy Ziqian Liu
, Mohammad Alsheikh-Kassim
, Jennifer K. Lang

Medicine

University at Buffalo

SUNY Buffalo

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Right-sided interatrial septal pouches (RSSPs) are an uncommon anatomical variant with unclear clinical significance. Case Summary: We present a unique case of a patient who was found to have a RSSP thrombus following an initial episode of pulseless electrical activity cardiac arrest, likely due to massive bilateral pulmonary embolism. Discussion: Existing literature on atrial septal pouches predominantly focuses on left-sided presentations and their potential clinical implications. Documented cases of RSSP are limited. Take-Home Message: RSSPs are uncommon anatomical variants that may serve as embolic sources even in the absence of traditional thrombotic risk factors. This case underscores the diagnostic importance of transesophageal echocardiography which may identify RSSPs missed on routine transthoracic echocardiography or computed tomography.

Original language	English
Article number	105285
Journal	JACC: Case Reports
Volume	30
Issue number	30
DOIs	https://doi.org/10.1016/j.jaccas.2025.105285
State	Published - Oct 1 2025

Keywords

congenital heart defect
echocardiography
thrombus

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10.1016/j.jaccas.2025.105285

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title = "Right-Sided Septal Pouch Thrombus: An Unrecognized Source of Embolism",

abstract = "Background: Right-sided interatrial septal pouches (RSSPs) are an uncommon anatomical variant with unclear clinical significance. Case Summary: We present a unique case of a patient who was found to have a RSSP thrombus following an initial episode of pulseless electrical activity cardiac arrest, likely due to massive bilateral pulmonary embolism. Discussion: Existing literature on atrial septal pouches predominantly focuses on left-sided presentations and their potential clinical implications. Documented cases of RSSP are limited. Take-Home Message: RSSPs are uncommon anatomical variants that may serve as embolic sources even in the absence of traditional thrombotic risk factors. This case underscores the diagnostic importance of transesophageal echocardiography which may identify RSSPs missed on routine transthoracic echocardiography or computed tomography.",

keywords = "congenital heart defect, echocardiography, thrombus",

author = "Liu, \{Ivy Ziqian\} and Mohammad Alsheikh-Kassim and Lang, \{Jennifer K.\}",

note = "Publisher Copyright: {\textcopyright} 2025",

year = "2025",

month = oct,

day = "1",

doi = "10.1016/j.jaccas.2025.105285",

language = "English",

volume = "30",

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}

TY - JOUR

T1 - Right-Sided Septal Pouch Thrombus

T2 - An Unrecognized Source of Embolism

AU - Liu, Ivy Ziqian

AU - Alsheikh-Kassim, Mohammad

AU - Lang, Jennifer K.

PY - 2025/10/1

Y1 - 2025/10/1

N2 - Background: Right-sided interatrial septal pouches (RSSPs) are an uncommon anatomical variant with unclear clinical significance. Case Summary: We present a unique case of a patient who was found to have a RSSP thrombus following an initial episode of pulseless electrical activity cardiac arrest, likely due to massive bilateral pulmonary embolism. Discussion: Existing literature on atrial septal pouches predominantly focuses on left-sided presentations and their potential clinical implications. Documented cases of RSSP are limited. Take-Home Message: RSSPs are uncommon anatomical variants that may serve as embolic sources even in the absence of traditional thrombotic risk factors. This case underscores the diagnostic importance of transesophageal echocardiography which may identify RSSPs missed on routine transthoracic echocardiography or computed tomography.

AB - Background: Right-sided interatrial septal pouches (RSSPs) are an uncommon anatomical variant with unclear clinical significance. Case Summary: We present a unique case of a patient who was found to have a RSSP thrombus following an initial episode of pulseless electrical activity cardiac arrest, likely due to massive bilateral pulmonary embolism. Discussion: Existing literature on atrial septal pouches predominantly focuses on left-sided presentations and their potential clinical implications. Documented cases of RSSP are limited. Take-Home Message: RSSPs are uncommon anatomical variants that may serve as embolic sources even in the absence of traditional thrombotic risk factors. This case underscores the diagnostic importance of transesophageal echocardiography which may identify RSSPs missed on routine transthoracic echocardiography or computed tomography.

KW - congenital heart defect

KW - echocardiography

KW - thrombus

UR - https://www.scopus.com/pages/publications/105016491378

U2 - 10.1016/j.jaccas.2025.105285

DO - 10.1016/j.jaccas.2025.105285

M3 - Article

SN - 2666-0849

VL - 30

JO - JACC: Case Reports

JF - JACC: Case Reports

IS - 30

M1 - 105285

ER -

Right-Sided Septal Pouch Thrombus: An Unrecognized Source of Embolism

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