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Kandemir O, Boysan E, Circi R, Turker T, Cicekcioglu F. A Right Ventricular Mass With Intracavitary Obliteration: Tumor or Thrombus? Cureus 2023; 15:e50809. [PMID: 38249167 PMCID: PMC10796752 DOI: 10.7759/cureus.50809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 01/23/2024] Open
Abstract
A 47-year-old woman was admitted to the hospital because of dyspnea for the past three months. She was previously diagnosed with pulmonary embolism. She had been operated on for a colon tumor five years ago and no residual cancer was detected on oncological follow-up. Her transthoracic echocardiographic and transesophageal echocardiographic evaluation showed a hypertrophic right ventricle occupied by a 2.7 x 4.8 cm immobile mass obliterated to the right ventricle cavity. All the non-invasive tests were consistent with thrombus prediagnosis. She underwent surgery. Mass was resected from the right ventricle as much as possible. Histopathology of surgical material revealed metastatic spindle cell adenocarcinoma. We aim to increase the awareness of the differential diagnosis of thrombus or tumor, thereby leading to appropriate management.
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Affiliation(s)
- Ozer Kandemir
- Cardiovascular Surgery, Etlik Şehir Hastanesi, Ankara, TUR
| | - Emre Boysan
- Cardiovascular Surgery, Etlik Şehir Hastanesi, Ankara, TUR
| | - Renda Circi
- Cardiovascular Surgery, Etlik Şehir Hastanesi, Ankara, TUR
| | - Tugce Turker
- Cardiovascular Surgery, Etlik Şehir Hastanesi, Ankara, TUR
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Goh FQ, Leow AS, Ho JS, Ho AF, Tan BY, Yeo LL, Li TY, Galupo MJ, Chan MY, Yeo TC, Wong RC, Chai P, Sia CH. Clinical Characteristics, Treatment and Long-Term Outcomes of Patients with Right-Sided Cardiac Thrombus. Hellenic J Cardiol 2022; 68:1-8. [PMID: 35987512 DOI: 10.1016/j.hjc.2022.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 07/31/2022] [Accepted: 07/31/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Right-sided cardiac thrombus is rare and may be caused by venous thromboembolism, in association with medical devices or stasis of blood in atrial fibrillation and cardiomyopathies. Complications include pulmonary embolism (PE) and paradoxical stroke. Current data are limited and mostly from case series and PE registries. We aimed to describe the clinical characteristics, echocardiographic features, treatment and outcomes of right-sided cardiac thrombus patients. METHODS This was a retrospective observational study of 97 consecutive patients with right-sided cardiac thrombus detected on echocardiography. We studied co-morbidities, predisposing factors, thrombus characteristics and therapeutic interventions and assessed their associations with development of PE, paradoxical stroke, circulatory collapse and all-cause mortality. RESULTS Mean age was 58.7 years and 55/97 (56.7%) were female. Ischaemic heart disease, heart failure, chronic kidney disease and malignancy were common co-morbidities. Right atrial thrombus was often associated with medical devices while right ventricular thrombus was more commonly associated with cardiomyopathy. Thrombus mobility did not affect embolic events but was associated with greater short-term mortality. On multivariable analysis, anticoagulation (HR 0.25, 95% CI 0.09-0.68) and thrombus resolution (HR 0.28, 95% CI 0.13-0.62) were associated with greater survival. CONCLUSIONS Right-sided cardiac thrombus is rare but may have potentially life-threatening complications such as PE and paradoxical stroke. Further research is needed to determine optimal therapeutic strategies in this poorly-studied population.
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Affiliation(s)
- Fang Qin Goh
- National University Hospital, National University Health System, Singapore
| | - Aloysius St Leow
- National University Hospital, National University Health System, Singapore
| | - Jamie Sy Ho
- Academic Foundation Program, Royal Free London NHS Foundation Trust, United Kingdom
| | - Andrew F Ho
- SingHealth Duke-NUS Emergency Medicine Academic Clinical Program, Singapore; National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore; Pre-hospital and Emergency Care Research Centre, Health Services and Systems Research, Duke-NUS Medical School
| | - Benjamin Yq Tan
- Division of Neurology, Department of Medicine, National University Hospital, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Leonard Ll Yeo
- Division of Neurology, Department of Medicine, National University Hospital, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tony Yw Li
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Mary Joyce Galupo
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Mark Y Chan
- Department of Cardiology, National University Heart Centre Singapore, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tiong-Cheng Yeo
- Department of Cardiology, National University Heart Centre Singapore, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Raymond Cc Wong
- Department of Cardiology, National University Heart Centre Singapore, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ping Chai
- Department of Cardiology, National University Heart Centre Singapore, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre Singapore, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Anfinogenova ND, Vasiltseva OY, Vrublevsky AV, Vorozhtsova IN, Popov SV, Smorgon AV, Mochula OV, Ussov WY. Right Atrial Thrombosis and Pulmonary Embolism: A Narrative Review. Semin Thromb Hemost 2020; 46:895-907. [PMID: 33368111 DOI: 10.1055/s-0040-1718399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Prompt diagnosis of pulmonary embolism (PE) remains challenging, which often results in a delayed or inappropriate treatment of this life-threatening condition. Mobile thrombus in the right cardiac chambers is a neglected cause of PE. It poses an immediate risk to life and is associated with an unfavorable outcome and high mortality. Thrombus residing in the right atrial appendage (RAA) is an underestimated cause of PE, especially in patients with atrial fibrillation. This article reviews achievements and challenges of detection and management of the right atrial thrombus with emphasis on RAA thrombus. The capabilities of transthoracic and transesophageal echocardiography and advantages of three-dimensional and two-dimensional echocardiography are reviewed. Strengths of cardiac magnetic resonance imaging (CMR), computed tomography, and cardiac ventriculography are summarized. We suggest that a targeted search for RAA thrombus is necessary in high-risk patients with PE and atrial fibrillation using transesophageal echocardiography and/or CMR when available independently on the duration of the disease. High-risk patients may also benefit from transthoracic echocardiography with right parasternal approach. The examination of high-risk patients should involve compression ultrasonography of lower extremity veins along with the above-mentioned technologies. Algorithms for RAA thrombus risk assessment and protocols aimed at identification of patients with RAA thrombosis, who will potentially benefit from treatment, are warranted. The development of treatment protocols specific for the diverse populations of patients with right cardiac thrombosis is important.
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Affiliation(s)
- Nina D Anfinogenova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Oksana Y Vasiltseva
- Unit of Aorta and Coronary Artery Surgery, E. Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, Novosibirsk, Russia
| | - Alexander V Vrublevsky
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Irina N Vorozhtsova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Sergey V Popov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Andrey V Smorgon
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Olga V Mochula
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Wladimir Y Ussov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
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Seghda TAA, Yaméogo NV, Millogo GRC, Kagambega L, Kologo J, Boro T, Samadoulougou A, Zabsonré P. [Management and prognosis of pulmonary embolism associated with right heart thrombi: A prospective study at the University Hospital Yalgado Ouédraogo]. Ann Cardiol Angeiol (Paris) 2019; 68:65-70. [PMID: 30292445 DOI: 10.1016/j.ancard.2018.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 09/07/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To describe the management and evolution of high risk of death pulmonary embolism associated with right heart thrombi. MATERIAL AND METHODS We conducted a prospective cohort survey over a 54 month-period, from March 1st, 2012 to September 30th 2015. Were included all patients with pulmonary embolism and having high or intermediate-high risk of death. Patients were divided into two groups according to whether cardiac Doppler-echography found a thrombus in the right chambers or not (ICT+ vs. ICT-). The survival curves for the patients were obtained using the software STATA. RESULTS The prevalence of pulmonary embolism associated with right heart thrombi was 4% in our study. Thrombi were mobile, straight localization in all cases. The ICT+group was characterized by a significantly higher proportion of congestive heart and chronic lung disease. The proportion of patients' thrombolysis was significantly higher in the ICT-group. In the ICT+group, thrombolysis significantly reduced mortality giving a 30-day survival of 80% against 20% among patients receiving only heparin. CONCLUSION Pulmonary embolism associated with right heart thrombi including the atrium are not exceptional. These patients are at high risk of early death. Thrombolysis is significantly improving the mortality of pulmonary embolism associated with right-sided heart thrombi.
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Affiliation(s)
- T A A Seghda
- Service de Cardiologie, Centre Hospitalier Universitaire Yalgado Ouédraogo, 03 BP, 7022 Ouagadougou 03, Burkina Faso.
| | - N V Yaméogo
- Service de Cardiologie, Centre Hospitalier Universitaire Yalgado Ouédraogo, 03 BP, 7022 Ouagadougou 03, Burkina Faso
| | - G R C Millogo
- Service de Cardiologie, Centre Hospitalier Universitaire Yalgado Ouédraogo, 03 BP, 7022 Ouagadougou 03, Burkina Faso
| | - L Kagambega
- Service de Cardiologie, Centre Hospitalier Universitaire Yalgado Ouédraogo, 03 BP, 7022 Ouagadougou 03, Burkina Faso
| | - J Kologo
- Service de Cardiologie, Centre Hospitalier Universitaire Yalgado Ouédraogo, 03 BP, 7022 Ouagadougou 03, Burkina Faso
| | - T Boro
- Service de Cardiologie, Centre Hospitalier Universitaire Yalgado Ouédraogo, 03 BP, 7022 Ouagadougou 03, Burkina Faso
| | - A Samadoulougou
- Service de Cardiologie, Centre Hospitalier Universitaire Yalgado Ouédraogo, 03 BP, 7022 Ouagadougou 03, Burkina Faso
| | - P Zabsonré
- Service de Cardiologie, Centre Hospitalier Universitaire Yalgado Ouédraogo, 03 BP, 7022 Ouagadougou 03, Burkina Faso
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Yakar A, Yakar F, Atacan SÇ, Yıldız M, Üzün İ. Failure of Therapy at Premortem Diagnosed Pulmonary Thromboembolism. JOURNAL OF CLINICAL AND EXPERIMENTAL INVESTIGATIONS 2016. [DOI: 10.5799/jcei.328615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Gerstein NS, Brierley JK, Culling MD. Left ventricle thrombus after tranexamic acid for spine surgery in an HIV-positive patient. Spine J 2016; 16:e77-82. [PMID: 26523960 DOI: 10.1016/j.spinee.2015.10.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 09/02/2015] [Accepted: 10/22/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Our case highlights the underappreciated thrombotic risks of tranexamic acid (TXA) use in non-cardiac surgery and emphasizes the need to elucidate these risks with appropriate clinical trials. PURPOSE The use of TXA in non-cardiac surgery has significantly expanded in the past 5 years, especially after the 2010 publication of the CRASH-2 Trial. We submit a case with the intent to highlight the thrombotic risk of TXA use during non-cardiac surgery and discuss the need for careful risk stratification before the use of TXA in this context. STUDY DESIGN A 66-year-old man with long-standing HIV infection, hypertension, and no history of coronary artery disease (CAD) presented for revision spinal fusion surgery with the use of TXA is presented. METHODS To limit perioperative blood loss, the case patient received TXA intraoperatively. His operative course was uneventful. RESULTS During the first 12 hours postoperatively the patient was noted to have persistent tachycardia and ST-elevation on electrocardiogram. Echocardiography showed a new apical wall motion abnormality and a left ventricle thrombus; cardiac catheterization confirmed two-vessel CAD, treated with a bare-metal stent and anticoagulation. CONCLUSIONS The thrombotic risks of TXA use in non-cardiac surgery have yet to be adequately studied in clinical trials. Hence, TXA use in this context is still an area of uncertainty, and its thrombogenic risks have yet to be studied as a primary outcome in any large prospective trial to date. Patients with any hypercoagulable risk factors, including HIV infection or any prior thrombotic history in which TXA use is being considered, should prompt a discussion among the perioperative physicians involved.
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Affiliation(s)
- Neal Stuart Gerstein
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, MSC 10 6000, 2211 Lomas Blvd NE, Albuquerque, New Mexico 87106, USA.
| | - Janet Kathryn Brierley
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, MSC 10 6000, 2211 Lomas Blvd NE, Albuquerque, New Mexico 87106, USA
| | - Matthew Douglas Culling
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, MSC 10 6000, 2211 Lomas Blvd NE, Albuquerque, New Mexico 87106, USA
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Chernyavsky AM, Chernyavsky MA, Fomicheva AV, Doronin DV. Successful Endovascular Thrombus extraction from the Right Auricle of the Patient Presenting with the Massive Fixed Right Heart Thrombus. ACTA ACUST UNITED AC 2015. [DOI: 10.17116/flebo20159347-50] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Shammas NW, Padaria R, Ahuja G. Ultrasound-assisted lysis using recombinant tissue plasminogen activator and the EKOS EkoSonic endovascular system for treating right atrial thrombus and massive pulmonary embolism: A case study. Phlebology 2014; 30:739-43. [DOI: 10.1177/0268355514555387] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective Right atrial thrombus in the setting of a large pulmonary embolus is rare and is associated with serious adverse events. This case report presents the role played by EKOS EkoSonic ultrasound system in successfully treating right atrial thrombus and massive pulmonary embolism. Case report A 69-year-old female presented with a massive pulmonary embolus and a large mobile right atrial thrombus. She was treated with catheter-directed lysis using the EKOS EkoSonic ultrasound system and tissue plasminogen activator, with complete resolution of her right atrial thrombus and a marked improvement in her pulmonary embolus and hemodynamics. Conclusion This case report provides a new and an effective option to treat right atrial thrombus associated with a large pulmonary embolus leading to a good outcome.
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Affiliation(s)
- NW Shammas
- Midwest Cardiovascular Research Foundation, IA, USA
- Cardiovascular Medicine, PC, IA and IL, USA
- Genesis Heart Institute, IA, USA
| | - R Padaria
- Cardiovascular Medicine, PC, IA and IL, USA
- Genesis Heart Institute, IA, USA
| | - G Ahuja
- Genesis Heart Institute, IA, USA
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