Giant Right Atrial Thrombus associated with Tunneled Cuffed Hemodialysis Catheter: A Case of Successful Treatment with Thrombolytic Agent and Anticoagulant

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Kosin Med J. 2013;28(1):61-65

Publication date (electronic) : 2013 January 19

doi : https://doi.org/10.7180/kmj.2013.28.1.61

Young Jin Song ¹, Young-Ki Lee^,¹, Sun Ryoung Choi ¹, Ji-Hyun Kim ¹, Sun Woo Kim ¹, Jung-Woo Noh ²

¹Department of Internal Medicine, College of Medicine, Hallym University, Seoul, Korea

²Hallym Kidney Research Institute, College of Medicine, Hallym University, Seoul, Korea

Corresponding author: Young-Ki Lee, Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, 948-1, Daelim-dong, Yeongdeungpo-gu, Seoul 150-950, Korea TEL: +82-2-829-5214 FAX: +82-2-848-9821 E-mail: km2071@unitel.co.kr

Received 2012 December 23; 2012 December 26; Accepted 2013 January 07.

Abstract

There are a variety of tunneled cuffed hemodialysis catheter-related complications including infection, thrombus formation, and catheter dysfunction. Catheter-related thrombus in right atrium is a rare complication and treatment guideline for atrial thrombus does not exist. A 3.0×2.8 cm sized giant atrial thrombus was found in a 35-year-old female hemodialysis patient. She was treated with catheter removal, thrombolysis and anticoagulation therapy. Size of atrial thrombus was gradually decreased and left ventricular systolic function was clearly improved after treatment. We experienced and reported a case of giant right atrial thrombus associated with tunneled cuffed hemodialysis catheter that was successful treated with thrombolytic agent and anticoagulant.

Keywords: Catheter; Renal Dialysis; Thrombolytic Therapy; Thrombosis

Fig. 1.

Chest PA shows cardiomegaly, bilateral pleural effusion and a central venous catheter. Tip of catheter through right internal jugular vein is located at right atrium.

Fig. 2.

Electrocardiography shows T-wave inversion in lead V1-3. But there in no significant change for previous study.

Fig. 3.

(A) Transthorasic echocardiography shows a 3.0×2.8 cm sized mass in right atrium on admission. (B) After 2 months, echocardiography shows a 1.0×1.7 cm sized mass. (C) After 6 months, echocardiography shows no mass in right atrium.

Fig. 4.

Chest CT agiography shows low-attenuated filling defect in the right atrium (arrow), attached to the tunneled cuffed hemodialysis catheter.

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