Patient in chronic hemodialysis with right atrial mass: thrombus, fungal
            endocarditis or atrial myxoma?

Salani, Talita G.; Borges, Cynthia de Moura; Urbini, Carolina S.; Schincariol, Patrícia; Quadros, Kélcia Rosana da Silva; Ribeiro-Alves, Maria Almerinda; Oliveira, Rodrigo Bueno de

doi:10.5935/0101-2800.20160073

Cited by 6 publications

(6 citation statements)

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“…Our search produced a total of eight case series encompassing 32 cases and 32 additional individual case reports. 7–46 Same-patient CRAT recurrences were described in five reports 9,13,14,19,24 for a total of 68 cases of CRAT among 63 patients. Table 1 provides demographic details.…”

Section: Resultsmentioning

confidence: 98%

Catheter-related right atrial thrombosis

2019

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Introduction: Catheter-related right atrial thrombosis is an under-recognized complication of central venous catheter placement. We performed a retrospective review, characterizing clinical aspects of catheter-related right atrial thrombosis (CRAT). Methods: To identify cases, a literature search was conducted in PubMed and additional items selected by review of related items and bibliography review. Key clinical data were extracted and analyzed both in total and as stratified by hemodialysis versus non-hemodialysis groups. Results: A total of 68 catheter-related right atrial thrombosis events were reported in 63 patients (five recurrences, of which 4 involved catheter left in place following primary treatment). Median (interquartile range) time to CRAT diagnosis was longer among hemodialysis patients – 12 (4.0–24.0) weeks compared to 5.5 (1.8–16.1) weeks among non-hemodialysis patients. The most common presentations were asymptomatic in 16/68 (23.5%), fever/sepsis in 21/68 (30.9%), pulmonary embolism in 11/68 (16.2%), catheter dysfunction in 8/68 (11.8%), dyspnea in 8/68 (11.8%), and new murmur or valvular dysfunction in 8/68 (11.8%) patients. Primary treatment selection was anticoagulation in 33/68 (48.5%), surgical thrombectomy in 17/68 (25.0%), thrombolysis in 12/68 (17.6%), or no active therapy in 6/68 (8.8%) patients. Primary treatment failure for anticoagulation and thrombolysis was 27.3% and 33.3%, respectively. The most common rescue therapy was surgical thrombectomy, ultimately resulting in an overall rate of 26/62 (41.9%). Overall, per-patient mortality was 13/63 (20.6%). Intracardiac tip position – 27/34 (79.4%) – overshadowed thrombophilia – 16/63 (25.4%) – as a risk factor for CRAT. Conclusion: Catheter-related right atrial thrombosis is an underdiagnosed complication of central venous catheter placement. For the hemodialysis population, a fistula-first approach is advocated. While many instances were asymptomatic, the development of unexplained fever, dyspnea, catheter dysfunction, or new murmur should trigger a search for this complication.

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Section: Resultsmentioning

confidence: 98%

Catheter-related right atrial thrombosis

2019

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“…Subsequent echocardiographic identification of the catheter-attached fibrin-thrombin-cellular matrix or biomass is so common as to be considered generally benign. It is reported that portions of the fibrinthrombin biomass may remain adherent to the catheter or conversely may be sheared off and even remain in the venous system at the time of catheter removal through the skin [24][25][26]. As they are often identified in the subclavian veins, right atrium, superior vena cava (SVC) or right ventricle (RV), a knowledgeable echocardiographer will infer their presence and related etiology to a current or recently removed catheter [24][25][26].…”

Section: Discussionmentioning

confidence: 99%

Hemodialysis Catheter-related Masses Case Report the Pro Inflammatory State in Chronic Kidney Disease

2019

JCRC

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Indwelling venous catheters provide essential functional vascular access for patients requiring emergent or urgent hemodialysis, though their long-term use is practically limited by known complications including increased rates of infection as compared with surgically created arteriovenous (AV) fistulas. Converging lines of evidence also support that chronic kidney disease (CKD) represents a pro-inflammatory state, an environment with active cellular and inflammatory pathobiology. Accordingly, implantation of catheters for even short-term use is associated with a fibrinthrombin-cellular matrix often forming around the catheter. This "biomass" long considered innocuous, can cause occlusion of the catheter, contributing to reduced flow rates during dialysis. It may also result in embolic injury of downstream structures. This case report identifies a complex catheter-related biomass remaining after removal of the hemodialysis catheter and focuses on two concerns. First, intravenous masses associated with the catheter, or remaining after removal may provoke embolic and direct hemodynamic-related injury. But perhaps less obvious is their potential linkage to vascular immunoreactivity found in CKD. This latter potential may need to be part of the larger discussion surrounding the outcomes of such pathologic immunoresponsiveness in CKD patients on hemodialysis. www.opastonline.com J Clin Rev Case Rep, 2019 Volume 4 | Issue 1 | 2 of 4 www.opastonline.com J Clin Rev Case Rep, 2019 Volume 4 | Issue 1 | 4 of 4 Copyright: ©2019 Dr. John D Rozich, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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“…After 180 days of anticoagulation, there was significant reduction in mass. 14 RA thrombus is seen in 4% of patients diagnosed as PE and is associated with increased mortality. 15 Treatment options are controversial as there are limited data for comparison.…”

Section: Discussionmentioning

confidence: 99%

Right Atrial Thrombus Mimicking Myxoma

Nemani

Killi

2017

Ind J Car Dis Wom

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Right atrial mass could be a tumor, thrombus, or vegetation, and it often poses a diagnostic dilemma. Accurate diagnosis is crucial to planning the correct management strategy. However, despite the advanced and sophisticated diagnostic modalities available, differentiating intracardiac masses could still be challenging. Clinical presentation leads to the appropriate conduit of investigations, and histopathology is confirmatory. When the diagnostic dilemma persists even after all efforts, clinical scenario should be strongly reconsidered, especially in unique clinical settings before concluding a diagnosis. In this article, the authors describe the case of a young woman with history of peripheral arterial thrombosis, who underwent surgical excision of a right atrial mass diagnosed as right atrial myxoma. She later presented with massive pulmonary embolism and deep vein thrombosis of the lower limbs. In view of her extensive thrombotic history, her entire case was reviewed including the histopathology slides, and the diagnosis of right atrial thrombus was considered and confirmed. On further workup for thrombotic state, she was found to have protein C deficiency.

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Patient in chronic hemodialysis with right atrial mass: thrombus, fungal endocarditis or atrial myxoma?

Cited by 6 publications

References 0 publications

Catheter-related right atrial thrombosis

Catheter-related right atrial thrombosis

Hemodialysis Catheter-related Masses Case Report the Pro Inflammatory State in Chronic Kidney Disease

Right Atrial Thrombus Mimicking Myxoma

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