Central Venous Catheter Mechanical Irritation of the Right Atrial Free Wall:A Cause for Thrombus Formation

Abstract

Thromboembolism is a major complication of long-term central venous catheter, usually associated with catheter or venous occlusion. Intracavitary right atrial thrombosis is currently considered to result from line-tip thrombosis extension. We report three adult patients in whom repeated mechanical trauma to the right atrial wall was probably the main mechanism. Transesophageal echocardiography revealed back and forth movement of the central catheter into a thrombus attached to the right atrial wall, thus suggesting a mechanism of catheter-associated thrombus formation, not previously visualized or suggested. Catheter removal and anticoagulation administration were undertaken with an uneventful clinical course and almost complete disappearance of the thrombi on transesophageal echocardiography follow-up.

A critical review of thromboembolic complications associated with central venous catheters

“…While most CVC-related thrombi extending into the heart are type-A, case series suggest that type-B thrombi can result from CVC-induced, mechanical irritation of the atrial wall. 21 Pulmonary embolism and death are reported to occur with 98 and 40% of type-A and 42 and 4% of type-B RAT, respectively. 1 Right atrial thrombi are suspected and described with increasing frequency.…”

The Cardiac Mass; Is it A Thrombus, Tumor or Vegetation? Take it in the Context of the Disease

“…While prosthetic valves have some inherent degree of obstruction, a close look at this view reveals a lesion on the valve [9]. TEE confirmed the diagnosis.…”

Unusual cause of superior vena cava syndrome diagnosed with transesophageal echocardiography

“…9 In this case, catheter tip location in the RA may have been a predisposing factor for thrombus formation, owing to catheter irritation of the RA endocardium. 10,11 In addition, our patient presented several risk factors for fungemia, including diabetes mellitus, renal failure, hemodialysis, and previous antibiotic exposure. 12 The most common complication of fungal endocarditis is embolism (as seen in our patient), although congestive heart failure, sepsis, and other complications have also been reported.…”