Right atrial thrombus mimicking cardiac myxoma: surgical and postoperative management

Intra-atrial thrombi, though rare, can develop in either atrium, with a higher prevalence in the left atrium. The causes are often difficult to determine, leading many cases to be classified as having uncertain origins. We present the case of a 35-year-old non-smoking male with a history of deep vein thrombosis who experienced worsening shortness of breath and pleuritic chest pain. Echocardiography revealed a right atrial thrombus extending into the left atrium through a patent foramen ovale. The thrombus was surgically excised; however, the patient developed postoperative complications, including pericardial effusion, pulmonary embolism, and acute liver injury. Following treatment and close monitoring, his condition stabilized, and he was discharged on anticoagulation therapy. Diagnosing intra-atrial thrombi presents significant challenges due to a broad differential diagnosis. Accurate assessment often requires multimodal imaging techniques, including echocardiography, CT angiography, and PET scans. Treatment options include anticoagulation, thrombolysis, and surgical thrombectomy, but there is no universal consensus on the optimal management approach. Therefore, early detection of intra-atrial thrombi, timely surgical intervention when indicated, and vigilant postoperative monitoring with continued anticoagulation are essential for improving patient outcomes. Consequently, further research is necessary to elucidate the underlying etiologies and enhance diagnostic and therapeutic strategies for this rare condition.