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.