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

Young Jin Song; Young-Ki Lee; Sun Ryoung Choi; Ji-Hyun Kim; Sun Woo Kim; Jung-Woo Noh

doi:10.7180/kmj.2013.28.1.61

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Song, Lee, Choi, Kim, Kim, and Noh: Giant Right Atrial Thrombus associated with Tunneled Cuffed Hemodialysis Catheter: A Case of Successful Treatment with Thrombolytic Agent and Anticoagulant

Case Report

Kosin Medical Journal 2013;28(1):61-65.

Published online: 19 January 2013

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

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

Young Jin Song¹, Young-Ki Lee¹, Sun Ryoung Choi¹, Ji-Hyun Kim¹, Sun Woo Kim¹, Jung-Woo Noh²

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 23 December 201226 December 2012 Accepted 7 January 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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

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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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