Right ventricular thrombus is an uncommon pathology, increasingly detected since the advent and development of echocardiography. The diagnosis of right ventricular thrombi before the imaging era was autopsy [5].

Multimodal cardiovascular imaging has become a mainstay in the diagnosis of intracardiac masses. Transthoracic echocardiography, a non-invasive, rapidly achievable examination, available at the patient's bedside in intensive care units, is the first-line examination for the detection of intracardiac thrombosis with a sensitivity of 50-60% [2].

There are 3 types of right cavity thrombus [7,8]: Type A: serpentine shape, very mobile, often associated with DVT and PE. This suggests that this type of thrombus is always in transit in the RV from a DVT. Type B: Non-mobile, builds up in situ, often on a pathological heart. Type C: rare, myxoma-like appearance, very mobile.

Transoesophageal echocardiography has the advantage of being more sensitive and more precise for estimating the size of right cavities thrombus [2].  Cardiac MRI, due to its high signal resolution, allows a better characterization of intracardiac masses and their mobility [9].

Thrombi of the right ventricle are seldom reported in the literature. For our patient, and after exhaustive etiological research, the etiology retained is oral contraception. A hormonal origin has also been implicated in a young man [10] candidate for sexual reassignment surgery under testosterone. And in 2 young patients on oral contraception, in whom the etiological assessment led to the respective diagnosis of an antiphospholipid syndrome [11] and a post-traumatic myocardial contusion [12]. Right ventricular thrombi have also been reported in the setting of myocardial infarction extended to the right ventricle [13], progressive neoplasia, nephrotic syndrome [14], hypereosinophilic syndrome [15], and in Behçet's disease [16].

The management of right cavity thrombi remains controversial in the absence of well-codified studies and recommendations. It usually involves anticoagulant treatment combined with specific treatment of the underlying pathology. The use of heparin or other anticoagulants may be considered in patients with a poorly mobile thrombus, as it is the case with our patient, she was treated with association of rivaroxaban and aspirine. According to a meta-analysis, there is no significant differences in the efficacy and the safety of use of NAOC compared to VKA [17]. However, curative anticoagulation for type A thrombi should be carried out carefully, given the slow duration of action, and the unpredictable evolution with a risk of massive pulmonary embolism [5]. Surgery remains the choice if there are difficulties in establishing the differential diagnosis with a tumour mass, particularly myxomas, or if anticoagulant treatment fails.

Our case has shown the interest of imaging in the diagnosis of intracardiac masses. The risk-benefit balance must be assessed before any prescription of oral contraception, given its potentially fatal complications. Etiological research must be broad. The use of DOAC is promising, it seems safe and does not require biological monitoring. A prospective, randomised study is crucial to better guide the management of these patients.