Calcified Thrombus in Right Atrium: Rare but Treatable Complication of Long-term Indwelling Central Venous Catheter

Successful tricuspid valve repair and right atrial mass excision for calcified thrombus causing severe tricuspid regurgitation and near-occlusion of inferior vena cava

BACKGROUND

Calcified right atrial thrombus is rare and commonly occurs secondary to atrial fibrillation and long-term central venous catheterization which present risk for embolization. Treatment typically involves anticoagulation and antiplatelet therapy but rarely surgical excision can be performed, especially in patients with venous obstruction or concomitant valvular dysfunction.

CASE PRESENTATION

We present the case of a 69 year old symptomatic female with a history of atrial fibrillation and long-term venous catheterization found to have a large calcified right atrial thrombus causing inferior vena cava obstruction and severe tricuspid regurgitation. Patient underwent full median sternotomy with ascending arterial cannulation with superior vena cava and femoral venous cannulation. Intraoperatively, extensive right atrial calcified thrombus was found extending into the inferior vena cava and involving the septal portion of the tricuspid valve annulus causing regurgitation. The calcified thrombus was removed which resolved the inferior vena cava obstruction and the tricuspid valve was repaired by transecting septal leaflet chordae, commissuroplasty, and ring annuloplasty. Postoperative course was uncomplicated and pathology confirmed a calcified right atrial thrombus. At 6 month follow up, the patient was asymptomatic with echocardiogram showing no inferior vena cava stenosis and trivial tricuspid regurgitation.

CONCLUSIONS

Surgical excision of calcified right atrial thrombus is rare and is often indicated for symptomatic patients with extensive involvement causing venous inflow obstruction or valvular dysfunction. Sufficient preoperative imaging and a multi-disciplinary approach are essential for accurate diagnosis to guide targeted treatment. When the tricuspid valve is involved, repair is preferred over replacement in this patient population given their propensity for calcification and thrombus formation which may result in an increased risk of early bioprosthetic valve degeneration or mechanical valve thrombosis.

Calcified Right Atrial Thrombus With Near-Systemic Pulmonary Pressures in a Morbidly Obese Patient: A Clinical Conundrum

Intracardiac masses are not uncommon, but a calcified right atrial thrombus (CRAT) is an exceedingly rare entity and often poses a diagnostic and therapeutic dilemma. We discuss the case of an incidentally noted CcRAT in a 40-year-old man presenting with progressive dyspnea. We further review the literature on the subject, highlighting the need for an individual patient-centred care plan.

CT and Sonographic Findings of a Calcified Fibrin Sheath From an Umbilical Venous Catheter in a Neonate

Central venous catheters are ubiquitous in current medical practice in intensive care units and for long-term nutrition, chemotherapy, and antibiotic therapies. Umbilical venous catheters provide short-term central vascular access and are used in the neonatal period. This case presents sonographic and CT imaging findings of an intrahepatic and intracardiac calcified fibrin sheath following removal of a short-term umbilical venous catheter in a 32-day-old premature neonate.

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

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.

Surgical Removal of a Calcified Right Atrial Mass Related to Venous Access Port: A Case Report

INTRODUCTION

Intracardiac masses pose a difficult diagnostic and therapeutic dilemma. Indwelling catheters can lead to thrombus calcification causing untoward sequelae.

CASE PRESENTATION

We report on a patient who presented after computed tomography identified a large calcified right atrial mass. Her history included treatment for rectal cancer and breast cancer, thus we feared the mass could represent metastasis. The intracardiac mass was successfully resected via a right atriotomy. Her postoperative course was uneventful and the histopathology revealed a calcified thrombus.

DISCUSSION

In this report we discuss our findings and pre- and intraoperative considerations, as well as suggestions for management of implantable venous catheters. This is a rare complication of an indwelling catheter.

CONCLUSION

Operative management of intracardiac lesions is the standard of care. When related to implantable catheters, the best patient care would be prevention of such lesions. This would include routine flushing of the indwelling catheters and prompt removal once not in use.