Large Right Atrial Thrombus Associated with Central Venous Catheter Requiring Open Heart Surgery
Central venous catheters (CVC) are used commonly in clinical practice. Incidences of CVC-related right atrial thrombosis (CRAT) are variable, but, when right atrial thrombus is present, it carries a mortality risk of 18% in hemodialysis patients and greater than 40% risk in nonhemodialysis patients....
Saved in:
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2012-01-01
|
| Series: | Case Reports in Medicine |
| Online Access: | http://dx.doi.org/10.1155/2012/501303 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832554557293461504 |
|---|---|
| author | Nasir Hussain Paul Eric Shattuck Mourad Hussein Senussi Erwin Velasquez Kho Mubeenkhan Mohammedabdul Devang K. Sanghavi Usman Mustafa Arvind Balavenkataraman Dragic M. Obradovic |
| author_facet | Nasir Hussain Paul Eric Shattuck Mourad Hussein Senussi Erwin Velasquez Kho Mubeenkhan Mohammedabdul Devang K. Sanghavi Usman Mustafa Arvind Balavenkataraman Dragic M. Obradovic |
| author_sort | Nasir Hussain |
| collection | DOAJ |
| description | Central venous catheters (CVC) are used commonly in clinical practice. Incidences of CVC-related right atrial thrombosis (CRAT) are variable, but, when right atrial thrombus is present, it carries a mortality risk of 18% in hemodialysis patients and greater than 40% risk in nonhemodialysis patients. Different pathogenic mechanisms have been postulated for the development of CRAT, which includes mechanical irritation of the myocardial wall, propagation of intraluminal clot, hypercoagulability, and hemodynamics of right atria. Presentation of CRAT may be asymptomatic or may be associated with one of the complications of CRAT like pulmonary embolism, systemic embolism, infected thrombi, or hemodynamic compromise. There are no established treatment guidelines for CRAT. We describe an interesting case of a 59-year-old asymptomatic male successfully treated with open heart surgery after failure of medical treatment for a large CRAT discovered during a preoperative evaluation for a kidney transplant. Our case underscores that early detection of CRAT may carry a favorable prognosis as opposed to waiting until catastrophic complications arise. It also underscores the importance of transesophageal echocardiography in the detection of thrombus and perhaps guides clinicians on which treatment modality to be used according to the size of the thrombus. |
| format | Article |
| id | doaj-art-3641d39f10c7403495e6eadae6191bf6 |
| institution | Kabale University |
| issn | 1687-9627 1687-9635 |
| language | English |
| publishDate | 2012-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Medicine |
| spelling | doaj-art-3641d39f10c7403495e6eadae6191bf62025-02-03T05:51:05ZengWileyCase Reports in Medicine1687-96271687-96352012-01-01201210.1155/2012/501303501303Large Right Atrial Thrombus Associated with Central Venous Catheter Requiring Open Heart SurgeryNasir Hussain0Paul Eric Shattuck1Mourad Hussein Senussi2Erwin Velasquez Kho3Mubeenkhan Mohammedabdul4Devang K. Sanghavi5Usman Mustafa6Arvind Balavenkataraman7Dragic M. Obradovic8Department of Internal Medicine, Saint Joseph Hospital, Resurrection Health Care, 2900 North Lake Shore Drive, Chicago, IL 60657, USADepartment of Internal Medicine, Saint Joseph Hospital, Resurrection Health Care, 2900 North Lake Shore Drive, Chicago, IL 60657, USADepartment of Internal Medicine, Saint Joseph Hospital, Resurrection Health Care, 2900 North Lake Shore Drive, Chicago, IL 60657, USADepartment of Internal Medicine, Saint Joseph Hospital, Resurrection Health Care, 2900 North Lake Shore Drive, Chicago, IL 60657, USADepartment of Internal Medicine, Saint Joseph Hospital, Resurrection Health Care, 2900 North Lake Shore Drive, Chicago, IL 60657, USADepartment of Internal Medicine, Saint Joseph Hospital, Resurrection Health Care, 2900 North Lake Shore Drive, Chicago, IL 60657, USADepartment of Internal Medicine, Saint Joseph Hospital, Resurrection Health Care, 2900 North Lake Shore Drive, Chicago, IL 60657, USADepartment of Internal Medicine, Saint Joseph Hospital, Resurrection Health Care, 2900 North Lake Shore Drive, Chicago, IL 60657, USADivision of Cardiology, Saint Joseph Hospital, Resurrection Health Care, Chicago, IL 60657, USACentral venous catheters (CVC) are used commonly in clinical practice. Incidences of CVC-related right atrial thrombosis (CRAT) are variable, but, when right atrial thrombus is present, it carries a mortality risk of 18% in hemodialysis patients and greater than 40% risk in nonhemodialysis patients. Different pathogenic mechanisms have been postulated for the development of CRAT, which includes mechanical irritation of the myocardial wall, propagation of intraluminal clot, hypercoagulability, and hemodynamics of right atria. Presentation of CRAT may be asymptomatic or may be associated with one of the complications of CRAT like pulmonary embolism, systemic embolism, infected thrombi, or hemodynamic compromise. There are no established treatment guidelines for CRAT. We describe an interesting case of a 59-year-old asymptomatic male successfully treated with open heart surgery after failure of medical treatment for a large CRAT discovered during a preoperative evaluation for a kidney transplant. Our case underscores that early detection of CRAT may carry a favorable prognosis as opposed to waiting until catastrophic complications arise. It also underscores the importance of transesophageal echocardiography in the detection of thrombus and perhaps guides clinicians on which treatment modality to be used according to the size of the thrombus.http://dx.doi.org/10.1155/2012/501303 |
| spellingShingle | Nasir Hussain Paul Eric Shattuck Mourad Hussein Senussi Erwin Velasquez Kho Mubeenkhan Mohammedabdul Devang K. Sanghavi Usman Mustafa Arvind Balavenkataraman Dragic M. Obradovic Large Right Atrial Thrombus Associated with Central Venous Catheter Requiring Open Heart Surgery Case Reports in Medicine |
| title | Large Right Atrial Thrombus Associated with Central Venous Catheter Requiring Open Heart Surgery |
| title_full | Large Right Atrial Thrombus Associated with Central Venous Catheter Requiring Open Heart Surgery |
| title_fullStr | Large Right Atrial Thrombus Associated with Central Venous Catheter Requiring Open Heart Surgery |
| title_full_unstemmed | Large Right Atrial Thrombus Associated with Central Venous Catheter Requiring Open Heart Surgery |
| title_short | Large Right Atrial Thrombus Associated with Central Venous Catheter Requiring Open Heart Surgery |
| title_sort | large right atrial thrombus associated with central venous catheter requiring open heart surgery |
| url | http://dx.doi.org/10.1155/2012/501303 |
| work_keys_str_mv | AT nasirhussain largerightatrialthrombusassociatedwithcentralvenouscatheterrequiringopenheartsurgery AT paulericshattuck largerightatrialthrombusassociatedwithcentralvenouscatheterrequiringopenheartsurgery AT mouradhusseinsenussi largerightatrialthrombusassociatedwithcentralvenouscatheterrequiringopenheartsurgery AT erwinvelasquezkho largerightatrialthrombusassociatedwithcentralvenouscatheterrequiringopenheartsurgery AT mubeenkhanmohammedabdul largerightatrialthrombusassociatedwithcentralvenouscatheterrequiringopenheartsurgery AT devangksanghavi largerightatrialthrombusassociatedwithcentralvenouscatheterrequiringopenheartsurgery AT usmanmustafa largerightatrialthrombusassociatedwithcentralvenouscatheterrequiringopenheartsurgery AT arvindbalavenkataraman largerightatrialthrombusassociatedwithcentralvenouscatheterrequiringopenheartsurgery AT dragicmobradovic largerightatrialthrombusassociatedwithcentralvenouscatheterrequiringopenheartsurgery |