ANSWER:

Right atrial thrombus.

Type: "Emboli in transit"

Characteristic:  Highly mobile, elongated-serpiginous mass.

Complication:  Always end up with pulmonary emboli. Any paradoxical emboli ?

Origin:  Mostly from pelvic or lower extremities deep vein thrombosis.

Differentiate:  From mural thrombus or right atrial tumor such as right atrial myxoma.

Transthoracic echo is about 50-60% sensitivity for detection of right heart thrombus and may underestimate the clot size.

Treatment:  anticoagulation, thrombolysis, surgery.

 

Other echo findings in this case included moderate right heart enlargement and significant pulmonary hypertension.

(Please contact Karen Hoftyzer for more information during the echocardiographic procedure.)

CURRENT REFERENCES

Rose PS, Punjabi NM, Pearse DB.
Treatment of right heart thromboemboli.
Chest. 2002 Mar;121(3):806-14.
 (Case presentation echocardiographic finding in this article is similar to our case here)

Tsoukas A, Marantidou P, Koliandris I I, Markakis N, Christakos S.
Echocardiography Detects and Demonstrates Disappearance of Right Atrial and Pulmonary Artery Thrombus: Case Report.
Echocardiography. 1999 Jul;16(5):431-433.

Hung MJ, Wang CH, Kuo LT, Cherng WJ.
Large right atrial thrombus with pulmonary embolism.
Echocardiography. 2000 May;17(4):329-34

Tsoukas A, Athanasopoulos G, Koliandris I I, Koutelou M, Ritsou M, Christakos S, Cokkinos DV.
Silent Pulmonary Embolism of a Large Right Atrial Thrombus.
Echocardiography. 1998 Jul;15(5):503-506.

Svedjeholm R, Broquist M, Wranne B.
Freely mobile right-sided atrial thrombus mimicking myxoma.
Eur J Cardiothorac Surg. 2001 Jul;20(1):195. No abstract available.

Kaushik ML, Sinha PK, Sharma A, Kashyap S.
Right atrial thrombus and pulmonary thromboembolism.
Indian J Chest Dis Allied Sci. 2002 Jan-Mar;44(1):45-8. No abstract available.

Roguin A, Reisner SA.
Right atrial mass related to indwelling central venous catheters in patients undergoing dialysis.
Eur J Echocardiogr. 2000 Sep;1(3):222-3.

Kingdon EJ, Holt SG, Davar J, Pennell D, Baillod RA, Burns A, Sweny P, Davenport A.
Atrial thrombus and central venous dialysis catheters.
Am J Kidney Dis. 2001 Sep;38(3):631-9.

Cesaro S, Paris M, Corro R, Svaluto G, Zanon F, Gamba P, Milanesi O, Messina C, Zanesco L.
Successful treatment of a catheter-related right atrial thrombosis with recombinant tissue plasminogen activator and heparin.
Support Care Cancer. 2002 Apr;10(3):253-5.

Wierzbowska K, Krzeminska-Pakula M, Marszal-Marciniak M, Drozdz J, Zaslonka J, Kasprzak JD.
Symptomatic atrial pacemaker lead thrombosis: detection by echocardiography and successful surgical treatment.
Pacing Clin Electrophysiol. 2001 Mar;24(3):391-3.

Barakat K, Robinson NM, Spurrell RA.
Transvenous pacing lead-induced thrombosis: a series of cases with a review of the literature.
Cardiology. 2000;93(3):142-8. Review.

Vincelj J, Sutlic Z, Biocina B, Nikic N, Lajtman Z.
Diagnostic accuracy of transesophageal echocardiography for detection of atrial masses.
Acta Med Croatica. 2001;55(1):47-51.