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.