Syncopal Status Revealing a Massive Intracardiac Thrombi Complicated by Pulmonary Embolism

Pulmonary embolism (PE) is a common condition characterized by clinical polymophism making its diagnosis difficult. Syncope as an initial symptom of pulmonary embolism has proven to be a difficult clinical correlation to establish, although described in the literature. It is more common in men than in women owing to its relationship with smoking and comorbid diseases. For patients younger than 55 years of age, the incidence rate of PE is higher in women owing to the use of oral contraceptives and pregnancy. Transthoracic echocardiography (TEE) is a vital examination diagnosis and stratification PE whereas Thoracic Angio computed tomography scan confirms PE diagnosis. We report a rare case of pulmonary embolism with a massive free-floating intracardiac thrombus that was revealed by recurrent episodes of syncope in a middle age patient followed-up for stable controlled type 2 diabetes mellitus under diet only without other known risk factor for thromboembolic disease.