Thrombolytic treatment of right atrial thrombus in a patient with B cell acute lymphoblastic leukemia: a case report

Right atrial thrombus is a severe complication of central venous catheterization (CVC). Concomitant pulmonary embolism may aggravate the clinical picture by causing or increasing shortness of breath and decreasing effort capacity, palpitations, and tricuspid valve regurgitation. A 32-year-old female patient with B cell acute lymphoblastic leukemia receiving chemotherapy was treated with alteplase thrombolysis because of the development of catheter-related right atrial thrombus and accompanying pulmonary embolism. On echocardiography, it was observed that the thrombus in the right atrium had regressed completely, but thrombus was seen in the right main pulmonary artery. The same dose of alteplase was given 2 days later. There was no significant change in the echocardiography. Therefore, ultrasound-assisted catheter-directed thrombolysis was applied. Clinical and radiological improvement was observed.