Document Detail

Catheter-related right atrial thrombus and pulmonary embolism: a case report and systematic review of the literature.
MedLine Citation:
PMID:  19851535     Owner:  NLM     Status:  MEDLINE    
Central venous catheters (CVCs) are commonly used in clinical practice. One of the foremost complications associated with their use is the potential for symptomatic or asymptomatic thrombosis. CVC thrombosis, in turn, may not only result in vascular and catheter occlusion but also infection, pulmonary embolism, and formation of right heart thromboemboli. Thrombi within cardiac chambers are associated with an increased risk of mortality due to their potential for embolization to the pulmonary vasculature. We describe the case of a 77-year-old man, who was successfully thrombolyzed following detection of a right atrial thrombus and hemodynamically significant pulmonary embolism resulting from thrombus formation on the tip of a peripherally inserted central catheter (PICC). The present article is the first report of a PICC-related right atrial thrombus in an adult treated with thrombolysis. A systematic review of the literature suggests that the true incidence of this complication may be underestimated because the diagnosis may not be considered in asymptomatic and symptomatic patients, or may be missed by transthoracic echocardiography. The present case highlights the importance of maintaining a high index of suspicion for thromboembolic complications and heparin-induced thrombocytopenia in patients with CVCs or a PICC. It also underscores the important role of transesophageal echocardiography and thrombolysis in the diagnosis and management, respectively, of right heart thromboemboli with associated pulmonary embolism.
Karen E A Burns; Andrew McLaren
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Publication Detail:
Type:  Case Reports; Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Canadian respiratory journal : journal of the Canadian Thoracic Society     Volume:  16     ISSN:  1916-7245     ISO Abbreviation:  Can. Respir. J.     Publication Date:    2009 Sep-Oct
Date Detail:
Created Date:  2009-10-23     Completed Date:  2010-12-08     Revised Date:  2013-05-31    
Medline Journal Info:
Nlm Unique ID:  9433332     Medline TA:  Can Respir J     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  163-5     Citation Subset:  IM    
Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada.
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MeSH Terms
Catheterization, Central Venous / adverse effects*
Echocardiography, Transesophageal
Heart Atria / ultrasonography
Heart Diseases / etiology*
Pulmonary Embolism / etiology*,  ultrasonography
Thrombosis / etiology*,  ultrasonography
Grant Support
//Canadian Institutes of Health Research

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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