Related Experiment Videos
[Right atrial thrombosis with concomitant thrombus attached to a central venous catheter. Clinical case]
R Nani1, P Novello, M Decastello
1Divisione di Cardiologia, Ospedale S. Maria dei Battuti, Treviso.
Insights
This case study highlights a patient who developed right atrial thrombosis, potentially linked to a central venous catheter (CVC). Prompt thrombolytic therapy successfully dissolved the clot, emphasizing early diagnosis for high-risk patients.
Area of Science:
- Cardiology
- Vascular Medicine
- Radiology
Background:
- Central venous catheters (CVCs) are crucial for patient care but can increase the risk of thrombosis.
- Identifying patients with multiple thrombogenic factors is essential for proactive management.
- Superior vena cava thrombosis is a serious complication requiring timely diagnosis and intervention.
Observation:
- A patient with multiple risk factors (age >60, cardiac arrhythmias, polyglobulia, CVC, low antithrombin III) developed right atrial thrombosis.
- Transthoracic echocardiography initially identified the thrombosis; chest X-ray with dye confirmed CVC involvement.
- Standard prophylactic measures (subcutaneous heparin, hydrophilic catheter) were insufficient in this high-risk individual.
Findings:
- Thrombolytic therapy using tissue plasminogen activator and heparin resulted in complete thrombus dissolution within 24 hours.
- Transesophageal echocardiography (TEE) and repeat CVC dye injection confirmed successful treatment.
- The case underscores the inadequacy of standard prophylaxis in high-risk CVC patients.
Implications:
- Patients with CVCs and multiple thrombogenic factors require enhanced diagnostic surveillance, including TEE and Doppler ultrasound.
- Early detection of superior vena cava thrombosis through imaging modalities like chest tomography and venography is critical.
- This case advocates for tailored thromboprophylaxis strategies in complex patient populations.
Abstract:
A clinical case of a patient in whom a right atrial thrombosis was casually discovered by transthoracic echocardiography is described. The hypothesis that also the central venous catheter (CVC) could be seat of thrombosis was done, and was confirmed by chest X-ray with dye injection in the CVC. A thrombolytic therapy with plasminogen tissular activator and with heparin infusion was started. After 24 hours from the beginning of therapy instrumental control were performed (transesophageal echocardiography ECOTEE, chest X-ray with dye injection in CVC), showing the completely dissolution of the thrombus. It is observed that, when in a patient with CVC high degree of thrombogenic factors (age over 60 years, presence of cardiac arrhythmias with ventricular hypokinesis, polyglobulia due to chronic obstructive pulmonary disease, CVC, low levels of antithrombin III) are present, the usual prophylactic measures (subcutaneous heparin, hydrophylic catheter) couldn't be sufficient to avoid superior caval vein thrombosis. The conclusion is drawn that these patient should be studied with ECOTEE and eco Doppler. Chest tomography and superior caval venography are also useful its early diagnosis of superior caval thrombosis.