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Massive right atrial thrombus

Massive right atrial thrombus Downloaded from https://academic.oup.com/ehjcr/article-abstract/3/3/ytz148/5571475 by Ed 'DeepDyve' Gillespie user on 01 October 2019 IMAGES IN CARDIOLOGY European Heart Journal - Case Reports (2019) 3, 1–2 doi:10.1093/ehjcr/ytz148 Cardiac imaging Willy Roque *, Eman Rashed , Anirudh Goyal, and James Maher Department of Medicine, Rutgers—New Jersey Medical School, 185 S Orange Ave, Newark, NJ 07103, USA Received 24 April 2019; first decision 20 May 2019; accepted 12 September 2019; online publish-ahead-of-print 18 September 2019 A transthoracic echocardiogram (TTE) was performed which Case description showed a normal sized right ventricle with normal function. Most A 70-year-old Caucasian man with a past medical history of hyper- notable was the presence of a large mobile echogenic mass swirling around in the right atrium, consistent with a thrombus in transit, ele- tension, significant smoking history, and atrial fibrillation presented to . the emergency department with complaints of chest pain and dizzi- . vated pulmonary artery systolic pressures, and severely reduced left ness. The chest pain began 5 h prior to presentation; it was described ventricular function (Figure 1). Computed tomography pulmonary as dull, retrosternal, non-radiating, and associated with a sensation of angiography demonstrated vermiform filling defects in the right dizziness. Of note, the patient had initially been prescribed apixaban, atrium extending to the inferior vena cava and right ventricle, dilation however, during an outpatient visit with his primary care physician, a of the right ventricle and right atrium with increased right cardiac decrease in haemoglobin was noted and due to concerns for gastro- pressures, segmental acute pulmonary embolism in the left lower intestinal bleed, apixaban was held 4 months prior to presentation. lobe, and chronic pulmonary embolism in the right main pulmonary An electrocardiogram showed atrial fibrillation with a rapid ventricu- artery extending to the proximal right middle lobe pulmonary artery lar response. Vitals upon arrival showed a blood pressure of 136/84, heart rate of 128 p.m., respiratory rate of 16 breath/min, and oxygen saturation of 97% with nasal cannula flow of 5 L/min. Physical exam was remarkable for an irregular heart rate and rhythm, and decreased breath sounds at the right lower lung base. Troponin levels were nor- mal. Chest X-ray demonstrated mild cardiomegaly and a right pleural effusion. Left venous lower extremity duplex was positive for deep vein thrombosis of the popliteal and gastrocnemius veins. . Figure 1 Transthoracic echocardiogram showing a large mobile Figure 2 Coronal view of thoracic computed tomography show- thrombus in the right atrium (RA) and crossing into right ventricle . ing a large vermiform filling defect in the right ventricle and atrium. (RV). * Corresponding author. Tel: (þ1)-973-972-6056, Email: wr160@njms.rutgers.edu Handling Editor: Gianluigi Savarese Peer-reviewers: Francesca Musella and Riccardo Liga V The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com Downloaded from https://academic.oup.com/ehjcr/article-abstract/3/3/ytz148/5571475 by Ed 'DeepDyve' Gillespie user on 01 October 2019 2 W. Roque et al. (Figure 2). Rate control management for atrial fibrillation and weight- Consent: The authors confirm that written consent for submission based protocol for venous thromboembolism with intravenous and publication of this case report including image(s) and associated 2 . unfractioned heparin infusion was initiated. Subsequently, the patient . text has been obtained from the patient in line with COPE guidance. was admitted to the cardiac care unit, with repeat TTE after 8 h, Conflict of interest: none declared. showing resolution of thrombus. References Supplementary material . 1. Shah CP, Thakur RK, Ip JH, Xie B, Guiraudon GM. Management of mobile right atrial thrombi: a therapeutic dilemma. J Cardiac Surg 1996;11:428–431. Supplementary material is available at European Heart Journal - Case . 2. Rose PS, Punjabi NM, Pearse DB. Treatment of right heart thromboemboli. Chest Reports online. 2002;121:806–814. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Heart Journal - Case Reports Oxford University Press

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References (3)

Publisher
Oxford University Press
Copyright
© The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology.
eISSN
2514-2119
DOI
10.1093/ehjcr/ytz148
Publisher site
See Article on Publisher Site

Abstract

Downloaded from https://academic.oup.com/ehjcr/article-abstract/3/3/ytz148/5571475 by Ed 'DeepDyve' Gillespie user on 01 October 2019 IMAGES IN CARDIOLOGY European Heart Journal - Case Reports (2019) 3, 1–2 doi:10.1093/ehjcr/ytz148 Cardiac imaging Willy Roque *, Eman Rashed , Anirudh Goyal, and James Maher Department of Medicine, Rutgers—New Jersey Medical School, 185 S Orange Ave, Newark, NJ 07103, USA Received 24 April 2019; first decision 20 May 2019; accepted 12 September 2019; online publish-ahead-of-print 18 September 2019 A transthoracic echocardiogram (TTE) was performed which Case description showed a normal sized right ventricle with normal function. Most A 70-year-old Caucasian man with a past medical history of hyper- notable was the presence of a large mobile echogenic mass swirling around in the right atrium, consistent with a thrombus in transit, ele- tension, significant smoking history, and atrial fibrillation presented to . the emergency department with complaints of chest pain and dizzi- . vated pulmonary artery systolic pressures, and severely reduced left ness. The chest pain began 5 h prior to presentation; it was described ventricular function (Figure 1). Computed tomography pulmonary as dull, retrosternal, non-radiating, and associated with a sensation of angiography demonstrated vermiform filling defects in the right dizziness. Of note, the patient had initially been prescribed apixaban, atrium extending to the inferior vena cava and right ventricle, dilation however, during an outpatient visit with his primary care physician, a of the right ventricle and right atrium with increased right cardiac decrease in haemoglobin was noted and due to concerns for gastro- pressures, segmental acute pulmonary embolism in the left lower intestinal bleed, apixaban was held 4 months prior to presentation. lobe, and chronic pulmonary embolism in the right main pulmonary An electrocardiogram showed atrial fibrillation with a rapid ventricu- artery extending to the proximal right middle lobe pulmonary artery lar response. Vitals upon arrival showed a blood pressure of 136/84, heart rate of 128 p.m., respiratory rate of 16 breath/min, and oxygen saturation of 97% with nasal cannula flow of 5 L/min. Physical exam was remarkable for an irregular heart rate and rhythm, and decreased breath sounds at the right lower lung base. Troponin levels were nor- mal. Chest X-ray demonstrated mild cardiomegaly and a right pleural effusion. Left venous lower extremity duplex was positive for deep vein thrombosis of the popliteal and gastrocnemius veins. . Figure 1 Transthoracic echocardiogram showing a large mobile Figure 2 Coronal view of thoracic computed tomography show- thrombus in the right atrium (RA) and crossing into right ventricle . ing a large vermiform filling defect in the right ventricle and atrium. (RV). * Corresponding author. Tel: (þ1)-973-972-6056, Email: wr160@njms.rutgers.edu Handling Editor: Gianluigi Savarese Peer-reviewers: Francesca Musella and Riccardo Liga V The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com Downloaded from https://academic.oup.com/ehjcr/article-abstract/3/3/ytz148/5571475 by Ed 'DeepDyve' Gillespie user on 01 October 2019 2 W. Roque et al. (Figure 2). Rate control management for atrial fibrillation and weight- Consent: The authors confirm that written consent for submission based protocol for venous thromboembolism with intravenous and publication of this case report including image(s) and associated 2 . unfractioned heparin infusion was initiated. Subsequently, the patient . text has been obtained from the patient in line with COPE guidance. was admitted to the cardiac care unit, with repeat TTE after 8 h, Conflict of interest: none declared. showing resolution of thrombus. References Supplementary material . 1. Shah CP, Thakur RK, Ip JH, Xie B, Guiraudon GM. Management of mobile right atrial thrombi: a therapeutic dilemma. J Cardiac Surg 1996;11:428–431. Supplementary material is available at European Heart Journal - Case . 2. Rose PS, Punjabi NM, Pearse DB. Treatment of right heart thromboemboli. Chest Reports online. 2002;121:806–814.

Journal

European Heart Journal - Case ReportsOxford University Press

Published: Sep 1, 2019

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