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Klimek J, Culcer M, Veerappan S. Spontaneously disappearing right atrial mass in a preterm infant: a case report. Eur Heart J Case Rep 2023; 7:ytad312. [PMID: 37501712 PMCID: PMC10369208 DOI: 10.1093/ehjcr/ytad312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/18/2022] [Accepted: 07/10/2023] [Indexed: 07/29/2023]
Abstract
Background There is currently a lack of evidence-based guidelines regarding ideal management of a neonate, specifically a preterm, with thrombo-embolus. There are no clear guidelines as to the time-frame of spontaneous resolution of a thrombo-embolus. Case summary A large pedunculated right atrial mass was identified on a clinician-performed cardiac ultrasound in a preterm neonate. The mass was smaller than half of the atrial size and was not causing obstruction. The mass disappeared spontaneously within 6 days and was retrospectively presumed to have been a thrombus. The neonate remained asymptomatic with no signs suggesting that the mass may have embolized. Discussion In this case of an incidentally identified asymptomatic intracardiac mass in a preterm infant, presumed to be a thrombus, our conservative 'wait and watch' approach was not associated with any adverse pulmonary or systemic effects.
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Affiliation(s)
- Jan Klimek
- Corresponding author. Tel: +61-2-88908748 or +61-2-88908911,
| | - Mihaela Culcer
- NICU, Westmead Hospital, Corner Darcy and Hawkesbury Roads, Westmead, Sydney, NSW 2145, Australia
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Intracardiac Thrombi in Preterm Infants-A Case Study and Review of the Literature. Diagnostics (Basel) 2023; 13:diagnostics13040764. [PMID: 36832252 PMCID: PMC9955841 DOI: 10.3390/diagnostics13040764] [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] [Received: 01/26/2023] [Revised: 02/12/2023] [Accepted: 02/13/2023] [Indexed: 02/19/2023] Open
Abstract
Intracardiac thrombi in preterm infants are not common but may lead to fatal outcomes. Predisposing and risk factors include small vessel size, hemodynamic instability, immaturity of the fibrinolytic system, indwelling central catheters and sepsis. In this paper, we present our own experience with a case of a catheter-related right atrial thrombus in a preterm infant, which was successfully treated with an aspiration thrombectomy. Then, we review the literature on intracardiac thrombosis in preterm infants: epidemiology, pathophysiology, clinical signs, echocardiographic diagnostic features and treatment options are discussed.
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Pasternack DM, Sharma M, Colavito J, Ramirez MM, Martinez MJ, Chakravarti S, Mosca R, Susheel Kumar TK. Neonatal Myxomas: Case Report and Literature Review. World J Pediatr Congenit Heart Surg 2022; 13:770-776. [DOI: 10.1177/21501351221126094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Myxomas are rare tumors in neonates and tend to have a different presentation compared to adults. We present an infant with a left atrial myxoma presenting with episodic tachycardia who underwent successful surgical excision. In addition, we performed a review of the literature, identifying 17 cases of neonatal myxomas. Unlike adults, neonatal myxomas are more common in males and occur more often on the right side of the heart. Constitutional symptoms such as fever or embolism are rare among neonates. Most patients have favorable outcomes following surgical excision, refuting earlier claims that neonatal myxomas are associated with poor outcomes.
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Affiliation(s)
- Daniel M Pasternack
- Department of Pediatrics (Cardiology), Hassenfeld Children’s Hospital at New York University Langone Medical Center, New York, NY, USA
| | - Madhu Sharma
- Department of Pediatrics (Cardiology), Children’s Hospital at Montefiore, Bronx, NY, USA
- Department of Pediatrics (Pediatric Cardiology), Albert Einstein College of Medicine, Bronx, NY, USA
| | - John Colavito
- Department of Pathology, New York University Langone Medical Center, New York, NY, USA
| | - Michelle M Ramirez
- Department of Pediatrics (Cardiology), Hassenfeld Children’s Hospital at New York University Langone Medical Center, New York, NY, USA
| | - Michael J Martinez
- Department of Pediatrics (Cardiology), Hassenfeld Children’s Hospital at New York University Langone Medical Center, New York, NY, USA
| | - Sujata Chakravarti
- Department of Pediatrics (Cardiology), Hassenfeld Children’s Hospital at New York University Langone Medical Center, New York, NY, USA
| | - Ralph Mosca
- Department of Pediatrics (Cardiology), Hassenfeld Children’s Hospital at New York University Langone Medical Center, New York, NY, USA
- Department of Cardiothoracic Surgery, New York University Langone Medical Center, New York, NY, USA
| | - TK Susheel Kumar
- Department of Pediatrics (Cardiology), Hassenfeld Children’s Hospital at New York University Langone Medical Center, New York, NY, USA
- Department of Cardiothoracic Surgery, New York University Langone Medical Center, New York, NY, USA
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Ramaswamy VV, Kudumula V, Prathik B, Sanghamitra GS, Suryanarayana N, Rama Rao PV, Surabhi HS, Niranjan HS. A case series of right atrial mass in neonates: a diagnostic dilemma. J Matern Fetal Neonatal Med 2019; 34:1508-1511. [PMID: 31238756 DOI: 10.1080/14767058.2019.1636961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The diagnosis of a right atrial mass in a neonate should be treated as an emergency. There are three major differential diagnoses for a right atrial mass-thrombus, infectious vegetation, and myxoma. Embolization of the mass can result in life-threatening complications and hence timely diagnosis and treatment is vital. This case series describes the clinical course, management, and outcome of four neonates who presented with a right atrial mass.
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Affiliation(s)
| | | | | | | | | | | | - H S Surabhi
- Indira Gandhi Institute of Child Health, Bangalore, India
| | - H S Niranjan
- Indira Gandhi Institute of Child Health, Bangalore, India
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