Right atrial thrombus leading to pulmonary embolism

Cross sectional and M mode echocardiography detected a large right atrial mass in a 70 year old man five days after admission. Three weeks later he developed acute respiratory failure due to a pulmonary embolism. Necropsy showed that the atrial mass was a thrombus. Thus echocardiography should be performed in patients with pulmonary emboli to examine the right cardiac cavities. The need for emergency surgery could then be assessed.     

Right atrial myxoma mistaken for recurrent pulmonary thromboembolism

A 69 year old man was admitted for investigation of right sided pleuritic chest pain and dyspnoea, both of which began suddenly four days before admission. Acute pulmonary embolism was diagnosed. Six months after discharge while on warfarin he died. Necropsy found a 50 mm diameter myxoid tumour arising on the right atrial side of the interatrial septum. This lesion may have been discovered earlier by echocardiography although there were no clear indications for this investigation. Presentation was that of recurrent pulmonary embolism with no obvious source or cause of thrombosis. Patients who are thought to have idiopathic pulmonary embolism should undergo early echocardiography to exclude the rare but treatable diseases of the right heart that may be responsible

Keywords: atrial myxoma     

Right atrial thrombus resembling myxoma

A patient who had a VVI pacemaker implanted 4 years ago presented with exertional dyspnea. He was found to have a large mobile ovoid mass in the right atrium attached to the lateral atrial wall apart from the pacing electrode. The tumor resembling a myxoma was removed successfully under cardiopulmonary bypass and found to be an organized thrombus.     

Right atrial thrombus in constrictive pericarditis.

We describe right atrial thrombus complicated by tricuspid valve obstruction in a patient with constrictive pericarditis. This report highlights the role of surgical thrombectomy, and the investigation of constrictive pericarditis to exclude intra-cardiac thrombus.     

Free floating thrombus in right atrium and pulmonary thromboembolism.

The authors describe a case of a patient with inoperable bladder cancer, who was admitted with syncope and arterial hypotension. After examination, an echocardiogram was requested, which showed a free-floating thrombus in the right atrium and dilatation of the right chambers. A diagnosis of pulmonary embolism was made, and heparin was started. The patient's clinical status worsened, with development of severe pulmonary hypertension due to the presence of large thrombi in the right and left pulmonary arteries. Despite a recent hemorrhagic event related to the bladder cancer, thrombolytic therapy was begun with improvement of the patient. The final echocardiogram was almost normal, without pulmonary hypertension and no dilatation of the right chambers.     

Large right atrial thrombus with pulmonary embolism

We present the cases of two patients, aged 67 and 77 years, who were admitted for the evaluation of rapidly progressive dyspnea and syncope, respectively. Both patients developed large right atrial thrombi with pulmonary embolism. The first patient received recombinant tissue plasminogen activator and survived with an uneventful result, whereas the second patient received operative thrombectomy followed by intravenous heparin and died 15 days later of pulmonary infarction with pulseless electrical activity. Data from these limited experiences suggest that thrombolytic therapy might be considered in patients with right heart thrombi with pulmonary embolism.     

Right pulmonary artery-to-left atrial fistula

Right pulmonary artery-to-left atrial fistula is a rare congenital anomaly. Contrast echocardiography and cardiac catheterization diagnosed a right pulmonary artery-to-left atrial fistula in a 24-year-old female with a history of cyanosis since childhood, and recurrent thromboembolism. She underwent successful surgical closure of the fistula.     

Right atrial thrombus following surgical closure of atrial septal defect--a case report

A case of an 11-year-old girl with atrial septal defect is described. The patient underwent surgical closure of the defect, which was complicated by asymptomatic thrombus formation in the right atrium. Anticoagulant therapy was initially successful, but thrombus recurred. Surgical thrombus removal was successful.     

Right atrial thrombus and recurrent pulmonary emboli secondary to permanent cardiac pacing--a case report and short review of literature

A patient with a right atrial thrombus and recurrent pulmonary emboli secondary to permanent pacemaker insertion is described. Possible precipitating factors were damage to the subclavian vein, congestive heart failure, paroxysmal atrial fibrillation, and immobilization. Venography demonstrated a large atrial thrombus in the superior vena cava and right atrium. The patient was successfully treated with heparin and subsequently with warfarin and dipyridamole.