"We have a tenant" a right atrial thrombus related to a central catheter

Area of Science:

• Cardiology
• Nephrology
• Vascular Surgery

Background:

• Hemodialysis tunneled catheters are essential for chronic kidney disease patients requiring renal replacement therapy.
• Catheter movement, driven by cardiac and respiratory cycles, poses a risk for vascular and cardiac complications.
• Mural thrombus formation is a potential complication linked to indwelling vascular devices.

Observation:

• A 36-year-old woman with a chronic hemodialysis catheter presented for pre-kidney transplant echocardiography.
• Echocardiography revealed an ovoid mass consistent with thrombus in the right atrium.
• The patient was asymptomatic, underscoring the silent nature of this complication.

Findings:

• The catheter tip's constant motion against the vessel or atrial wall can lead to mural thrombus.
• Right atrial thrombus formation is a documented, albeit uncommon, complication of hemodialysis catheters.
• Literature review confirms the association between catheter presence and thrombus development.

Implications:

• Routine echocardiographic evaluation may be warranted in select patients with chronic hemodialysis catheters.
• Early detection of catheter-related thrombus is crucial to prevent embolic events and guide management.
• This case emphasizes the need for vigilance regarding potential complications of long-term indwelling vascular catheters.