Original Articles
A retrospective experience of right atrial and superior vena caval thrombi diagnosed by transesophageal echocardiography*

https://doi.org/10.1067/mje.2002.116533Get rights and content

Abstract

Central venous catheter (CVC) thrombosis and infection has become a frequent finding in immunosuppressed and chronically ill medical patients, particularly those with end-stage renal disease. Transeophageal echocardiography (TEE), as the only reliable noninvasive method of imaging the superior vena cava (SVC) is appreciated to be very useful in the evaluation of these lesions. We retrospectively review our findings of TEE for this purpose, with regard to frequency of positive findings, patient characteristics, and microbiologic findings from SVC and right atrial thrombi and vegetations associated with CVCs. (J Am Soc Echocardiogr 2002;15:76-79.)

Section snippets

Methods

A retrospective database evaluation was done of all echocardiograms performed over a 10-month period at Rush-Presbyterian-St. Luke's Medical Center. All cases revealing a thrombus or vegetation in the right atrium or superior vena cava were noted. Even when these lesions were first detected on transthoracic echocardiography, all patients with these findings underwent TEE to better delineate their lesions (Figure 1).

. TEE images of RA and SVC thrombi. ESRD, end-stage renal disease; CVC, central

Results

Between May 1999 and March 2000, 610 TEE studies were performed in the echocardiography laboratory at the Rush Heart Institute. Fourteen patients (2.3%) were found to have masses in the right atrium or superior vena cava that were associated with central venous catheterization.

Table 1 summarizes the patient characteristics and findings of these 14 patients.

. Summary of patient characteristics and findings

Patient no.Age/sexESRD on hemodialysis (Y/N)Type of CVCDuration of CVC in place (wk)Other

Discussion

We were unable to pursue outcomes data; however, it is known that at least 2 patients were taken to the operating room for open clot/vegetation evacuation by a cardiothoracic surgeon, and 3 patients died before hospital discharge. The available literature on the subject of management of these patients is sparse. There have been other case reports and brief series discussing novel management techniques, such as catheter removal under TEE,10 and routine TEE surveillance of long-dwelling central

Conclusions

Superior vena cava and right atrial thrombi are occasional findings in a high-volume echocardiography laboratory. In our experience, they are usually infected. They are associated with multiple complex medical problems and immunosupression. Long dwell times of large-bore dialysis catheters seem to have a particularly strong association. In infected thrombosed superior caval or right atrial catheters, multiple infectious agents and atypical agents are common.

References (16)

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*

Reprint requests: Steven B. Feinstein, MD, Laboratory of Echocardiography, Rush Heart Institute, Rush-Presbyterian-St. Luke's Medical Center, 1015 Jelke Building, 1653 West Congress Parkway, Chicago, IL 60612 (E-mail: [email protected]).

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Copyright © 2002 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.