Surgical retrieval of PICC-related right atrial thrombus in a child with acute lymphoblastic leukemia: a case report

Abstract

Background Peripherally inserted central catheters (PICCs) are widely used in cancer patients for administering chemotherapy drugs, antibiotics, and nutrients. PICC-related thrombi are not uncommon and may result in pulmonary embolism and the formation of thrombi in the right atrium. The latter are associated with an increased risk of subsequent morbidity or mortality because of their potential for embolization in the pulmonary vasculature. Case presentation A 16-year-old male with acute lymphoblastic leukemia (ALL) was admitted to our hospital after an echocardiographic examination revealed a ring-like structure in the right atrium that was still present after 6 months’ anticoagulation treatment with aspirin. The boy had had a PICC inserted 2 years previously for chemotherapy; the PICC was intact and successfully removed 18 months after insertion when chemotherapy is finished. Subsequent computer tomography and radiography differentiated right atrial ring-shaped mass with a diameter of approximately 15 mm. Cardiac surgery was performed to remove the mass which was found to be a calcified thrombus. Conclusion Although this is a rare occurrence, recognition of the possibility of a calcified thrombus may minimize the misdiagnosis of PICC-related thrombus and allow surgical retrieval if the thrombus is sufficiently large.

First-in-paediatric uses of a mechanical aspiration system for percutaneous removal of right atrial masses

“…In previously reported cases of paediatric right atrial masses, treatment consisted of either surgical resection or anticoagulation. [5][6][7] In 2015, Khan and Momenah reported the percutaneous removal of a ventriculoatrial shunt-associated right atrial thrombus in a 12year-old using negative pressure from a 20 cc syringe. 8 Aspiration-based systems for vacuum-assisted thrombectomy of intracardiac masses in adults have attenuated the risk of haemolysis and bradyarrhythmia seen with the rheolytic devices, 4 but there is a paucity of paediatric data.…”

Right heart thrombus in transit and peripherally inserted central catheters

“…PICCs are widely inserted in clinical practice for the administration of chemotherapy, antibiotics, parenteral nutrition, haematopoietic stem cell transplantation and blood transfusion [ 1 , 2 ]. Most common complications associated with PICCs are venous thromboembolism (VTE), infection, accidental removal, line fracture and embolisation [ 1 ].…”

“…PICCs are widely inserted in clinical practice for the administration of chemotherapy, antibiotics, parenteral nutrition, haematopoietic stem cell transplantation and blood transfusion [ 1 , 2 ]. Most common complications associated with PICCs are venous thromboembolism (VTE), infection, accidental removal, line fracture and embolisation [ 1 ]. The risk of PICC associated DVT (PICC-DVT) is heightened with high body mass index, thrombocytosis, cancer and chemotherapy, inflammatory conditions, infections, recent surgery, smoking, characteristics of the catheter such as size, type, tip location, insertion site, and retention time.…”