Role of Transthoracic Echocardiography
Placement of CVC catheters with the intent of providing intermediate or
longer-term venous access (chemotherapy, hemodialysis) often takes place
under fluoroscopic guidance. Careful placement of the CVC catheter,
ideally at the cavoatrial junction may be preferred given the high
incidence of RAT noted in this study. In cases of SVC narrowing or
problems with flow that require more distal placement of the CVC
catheter, consideration should be given to periodic surveillance of for
thrombotic complications, especially in higher-risk patients. In one
third of patients in this analysis, RAT was noted within 30 days of
placement of the CVC, underscoring the fairly quick development of
thrombus. In each of these five cases, the catheter was removed or
replaced and four of these five cases, anticoagulation was also
prescribed resulting in thrombus resolution. TTE with adequate sweeps to
interrogate the body of the RA in addition to the CVC tip may enhance
the detection of intracardiac thrombus. When RAT is suspected based on
TTE imaging, subsequent imaging for TEE or CMR can be helpful to further
characterize the morphology, size, and attachment points of the mass.