Rapid dissolution of right atrial thrombus in a patient with congestive cardiomyopathy

The AA describe a patient with congestive cardiomyopathy, probably alcoholic, who exhibited signs and symptoms of congestive heart failure and a pericardial rub, due to a right atrial thrombus (4 X 2 cm). The thrombus dissolved completely and the symptoms decreased markedly after 14 days of oral anticoagulant therapy alone. We suggest that anticoagulant therapy should be considered before surgery, if an intracardiac mass with no signs of pulmonary embolism is found in a patient with cardiomyopathy.     

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.     

Echocardiographic appearances of right atrial thrombus

A 17-year-old male presented with a four-day history of increasing shortness of breath and right basal pleuritic chest pain. Physical examination revealed central and peripheral cyanosis, sinus tachycardia, elevation of central venous pressure, hypotension, and added third heart sound. Echocardiography (M-mode and two-dimensional) showed a highly mobile mass in the right atrium apparently attached to the interatrial septum. A diagnosis of right atrial myxoma with pulmonary embolization was made and urgent surgery advised. At operation a string of thrombus in the right atrium (presumed from peripheral venous site) occluding a patent foramen ovale was found. The usefulness of echocardiography in diagnosing atrial thrombus and in differentiating clot from tumor is discussed.     

Effectiveness of chemoembolization therapy for metastatic right atrial tumor thrombus associated with hepatocellular carcinoma

A rare case of hepatocellular carcinoma (HCC) was complicated by metastatic right atrial tumor thrombus (RATT), which diminished in size on echocardiograms and showed necrotic change on computed tomography (CT) scans after chemoembolization therapy.     

Echocardiographic demonstration of tricuspid valvulitis and right atrial thrombus complicating an infected artificial pacemaker:a case report

A right ventricular artificial demand pacemaker was implanted into a 59-year-old man with supra-Hisian complete heart block. His postoperative course was complicated by Staphylococcal aureus septicemia, which was controlled with antibiotics. A year later, S. aureus was again isolated from the blood. Echocardiography showed thickening of the tricuspid valve leaflet and multiple echoes in the right atrium. Autopsy findings included tricuspid leaflet thickening and an overlying right atrial thrombus. The echocardiogram is thus useful in localizing an infected valve in bacterial endocarditis and in demonstrating the presence of the thrombus.     

Right-to-left interatrial shunt with hypoxemia caused by a right atrial thrombus

A right-to-left shunt in the presence of normal pulmonary artery pressure is an unusual cause of hypoxemia in an adult who has a patent foramen ovale. We report a rare case of such a shunt-the result of a right atrial thrombus that formed in a hypercoagulable patient after placement of an indwelling central venous catheter for chemotherapy. In order to ascertain the nature of the right atrial mass and to decrease the risk of systemic embolization, the thrombus was surgically removed with the patient on cardiopulmonary bypass.     

Behcet's disease with a large and free right atrial thrombus.

We present a case of a 27-year-old male patient with Behcet's disease who presented with dyspnoea and haemoptysis in whom further investigation revealed a large and free right atrial thrombus and pulmonary thromboembolism. Considering the absence of haemodynamic compromise and the risk of recurrence after surgical treatment for cardiac thrombus, we preferred medical management which consisted of immunosuppression and anticoagulation. On a follow-up period of 12 months we observed complete dissolution of the thrombus and dramatic improvement of clinical status.     

Vacuum thrombectomy of large right atrial thrombus

We report a novel technique for percutaneous removal of the right heart thrombi using a suction cannula. This method allowed complete en bloc removal of the right atrial thrombus avoiding surgical procedure in a high risk patient.     

Resolution of right atrial thrombus following anticoagulation

A man with congestive heart failure, atrial fibrillation and increasing dyspnoea on exertion was shown to have a large right atrial thrombus and multiple pulmonary emboli. The patient was anticoagulated and a subsequent echocardiogram showed that the thrombus was no longer present. This report demonstrates the need for echocardiography in patients presenting with pulmonary emboli and questions the value of anticoagulation in patients with intracavitary thrombi.     

A unique pacemaker complication of thrombus formation in the right internal jugular vein due to unusual migration of an atrial pacemaker electrode

Our report describes the late migration of an atrial screw-in lead into the right internal jugular vein causing subsequent subclinical thrombus formation at the tip of the electrode. Previously initiated anticoagulation for atrial fibrillation may have prevented complete occlusion of the internal jugular vein. Therefore, prophylactic anticoagulation should be considered for patients in whom permanent pacing leads are dislodged into central veins and cannot be removed.     

Giant right atrial thrombus in premature newborn

Pediatric guidelines for treatment options of right atrial thrombosis in newborn are quite limited. Herein we present a case with giant atrial thrombosis resulting from umbilical venous catheter and intend to discuss the therapy in the area of current literature on right atrial thrombus in newborn and children.     

Giant right atrial thrombus in Noonan syndrome combined with Eisenmenger's complex

A 54-year-old woman with the Noonan syndrome was admitted with congestive heart failure and a giant right atrial thrombus with atrial septal defect detected by two-dimensional echocardiography. The thrombus vanished on oral anticoagulant therapy with warfarin. The thrombus is considered to result from hemostasis in the right atrium due to congestive heart failure and to her specific skeletal characteristics. This report describes the first case of Noonan syndrome with right atrial thrombus.     

Cardiac arrest in a patient with a mobile right atrial thrombus in transit and amyloidosis

Primary amyloidosis is a rare disorder in which insoluble fibersare deposited in tissue and organs, impairing their function.Cardiac involvement occurs in up to 50% of patients with primaryamyloidosis. We describe a case of a 75-year-old admitted to our departmentafter he had a sudden cardiac arrest due to massive bilateralthrombotic occlusion of the pulmonary arteries. The echocardiogramrevealed many atrial thrombi swirling inside the right atriumand protruding into the tricuspid valve partly occluding it.Severe concentric hypertrophy of the left ventricle was alsopresent with a preserved ejection fraction. The right ventriclewas dilated, hypertrophic and ipokinetic with a severe tricuspidalinsufficiency that permitted estimation of a severe pulmonaryhypertension. All these characteristics were highly suggestivefor an infiltrative form of hypertrophic cardiomyopathy. Thefinal diagnosis was amyloidosis.