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[Unusual location of mural thrombi in the right atrium caused by pathological changes in the sinoatrial node]
Insights
Post-mortem examinations revealed organized mural thrombi in the right atrium
Area of Science:
- Cardiovascular Pathology
- Cardiac Electrophysiology
Background:
- The antrum of the right atrium, housing the sinoatrial node, is susceptible to pathological processes.
- Endocardial involvement near the sinoatrial node can predispose to thrombus formation.
Observation:
- Two cases presented with organized mural thrombi in the antrum of the right atrium.
- Case 1: 52-year-old male with rheumatic heart disease, atrial fibrillation, and sinoatrial node degeneration.
- Case 2: 74-year-old male with hypertension, pyelonephritis, amyloidosis, and sinoatrial node infiltration.
Findings:
- Thrombi were found attached to the right atrial endocardium in the sinoatrial node region.
- Microscopic findings included sinoatrial node degeneration, inflammation, and vascular abnormalities.
- Amyloid deposition was noted in the sinoatrial node in the second case.
Implications:
- Pathological processes affecting the sinoatrial node can lead to mural thrombi formation in the right atrial antrum.
- These findings highlight a potential link between sinoatrial node pathology and atrial thrombosis.
- Further research may elucidate the clinical significance of these thrombi in cardiac conditions.
Abstract:
We present a post-mortem examination of two hearts in which we found organized mural thrombi attached to the right atrial endocardium in the recess called antrum atrii dextri. This region is a place where the sinus node is situated very close to the endocardium of right atrium. Any pathological process involving the node (inflammation, degeneration) may reach this part of endocardium by continuity, this in turn creates convenient conditions for mural thrombi formation. The first case--a 52-year old man who died of severe congestive heart failure caused by rheumatic disease with mitral and aortic stenosis. Atrial fibrillation had developed several years before his death. Apart from typical changes of mitral and aortic valves a post-mortem examination revealed an organized, globular thrombus in antrum atrii dextri. In the microscopical findings of the sino-atrial region the fatty degeneration of the sinus node with multiple mononuclear cell infiltration was the most striking feature. The sinus node artery was narrowed due to fibro-muscular dysplasia of its wall. The second case--a 74-years old man who suffered from arterial hypertension and chronic pyelonephritis with a history of heart infarct in the past. The ECG recording showed multifocal atrial rythm with variable P wave morphology and P-Q distance. At necropsy the whole heart was significantly enlarged with no scars or any other signs of healed infarct. The microscopical findings revealed the heart muscle to be infiltrated by amyloid deposits particularly apparent in the sinus node. Similar thrombus of 1.5 cm in diameter was found in antrum of the right atrium.(ABSTRACT TRUNCATED AT 250 WORDS)