Introduction
Central venous catheters (CVCs) are commonly utilized for a variety of
clinical purposes, including hemodialysis access, infusion of
medications such as chemotherapy, and total parenteral nutrition. The
reliable provision of vascular access with a CVC offers many advantages
in the management of chronic disease, and CVCs routinely remain in place
long-term. However, their presence also introduces the risk of
development of known complications such as infection, thrombotic
obstruction of the catheter lumen, and external thrombus development in
association with the catheter.1,2
CVCs are commonly placed such that the tip rests in the superior vena
cava (SVC), at the cavoatrial junction, or within the right atrium (RA)
itself. The development of right atrial thrombus (RAT) in association
with a CVC is a known complication which exhibits a strong association
with protrusion of the catheter tip into the right
atrium.3 RA thrombi have been implicated in septic
emboli, arrhythmia, and embolization to the pulmonary vasculature,
increasing the risk of morbidity and mortality.2,4-8
Although previous case reports and case series present instances of RAT,
evaluations of its incidence in the presence of CVCs have typically been
reported in small sample sizes and vary from 5.4% in hemodialysis
patients to nearly 30% based on autopsies of patients who died with a
CVC present.9,10 The primary purpose of this study was
to evaluate the incidence of development of catheter-associated RAT as
detected incidentally by transthoracic echocardiograms (TTEs) in
patients with a CVC tip in the RA. Secondarily, we characterize imaging
features of observed thrombi and the clinical features of the patients
with RAT, describe the utility of multiple modalities of follow-up
imaging for thrombus evaluation, and discuss thrombus management and
resolution in our study population.