Echocardiographic features of right atrial thrombi

Abstract

The clinical and echocardiographic features of six patients in whom a right atrial thrombus was detected using two-dimensional echocardiography are reported. In four patients with acute cor pulmonale, the thrombus appeared as a coiled mass moving freely within the right atrium and prolapsing through the tricuspid valve. In another patient referred for syncope, a large coiled mass attached to the lateral wall of the right atrium was seen prolapsing regularly through the tricuspid valve, simulating an atrial myxoma. In the remaining patient who presented with chronic cor pulmonale, two-dimensional echocardiography demonstrated a motionless ovoid mass with a broad base of attachment to the interatrial septum.

Dissolution Using Intravenous Streptokinase of a Right Atrial Thrombus Associated with Pulmonary Embolism

“…Thrombolytic therapy, on the other hand, has had contradictory results [2,4,6], In the pediatric literature, thrombolytic therapy has been used successfully to dissolve right atrial thrombus. However, these thrombi are usually secondary to indwelling cathe ters in the superior vena cava or right atrium and may represent a different morphologic entity [8,9], It has been suggested that thrombolytic therapy may promote embolization of a partially dissolved right atrial tion in an attempt to prevent embolization to the pulmo nary arteries.…”

“…Right atrial thrombectomy is a successful therapeutic modality [2,3,7], but it exposes the patient to the risks of open heart surgery and cardiopulmonary bypass. It was not considered in our patient.…”

“…However, at least two types of right atrial thrombus have been described [2][3][4][5], The immobile form is rounded and well attached to the right atrial wall. The mobile type appears serpen tine or fusiform and can be seen prolapsing through the tricuspid valve into the right ventricle in diastole.…”

“…The mobile floating thrombus is associated with mul tiple pulmonary emboli [2][3][4][5]. It is suggested that it represents 'venous cast', originating from deep venous thromboses which embolize.…”

“…It is suggested that it represents 'venous cast', originating from deep venous thromboses which embolize. In the heart, the thrombus becomes entrapped within the right atrial-tricuspid valve network, but it can migrate to the pulmonary arteries [5], It is often associated with right ventricular dysfunction, right ventricular infarct, and dilated congestive cardio myopathy [2,5,6].…”