Right atrial embolus. Echocardiographic features.

Abstract

SUMMARY Although the value of echocardiography in detecting left heart thrombus is well recognised, right atrial thromboembolism has rarely been identified in life. In two patients with pulmonary embolism of varying severity cross sectional echocardiography identified a thrombus moving freely within the right atium and clearly showed its string-like or even tubular structure. An embolectomy, based on the echocardiographic diagnosis, was undertaken successfully in one patient. The value of routine echocardiography in patients with suspected pulmonary embolism is yet to be confirmed.

Floating Right Heart Thrombi and Pulmonary Embolism: Diagnosis, Outcome and Therapeutic Management

“…Pulmo nary angiography is not needed and may be dangerous: it delays treatment and may induce dislodgment or frag mentation of the thrombus [3,10,13,15,17]. In our 2nd case, perfusion of contrast solution into the inferior vena cava was sufficient to dislodge the atrial thrombus.…”

“…11], and migration towards the pulmonary trunk is often fatal [1,8,10,11,15,17], Unfortunately, this is illustrated in our 3rd and 14th cases with sudden death occurring shortly after echo cardiography and the autopsy finding of a thrombus inside the pulmonary trunk. The move of the mobile right atrial thrombus from the right atrium towards the left atrium through a patent foramen ovale [18,19] is associ ated with the high risk of the paradoxical thrombus, which Nellessen [18] noticed in this report of the first échocardiographie (a transesophageal examination) view ing of a thrombus located in both atria.…”

“…Death frequently occurs when the throm bus moves towards the pulmonary trunk [1,8,10,11,15,17]. Thus the mobile right heart thrombus needs emergen cy care, but there is no clear consensus regarding thera peutic management [4].…”

“…Usual two-dimensional échographie descrip tions include three different features: a spheric or ovoid bullet-like shape [5], a lobular or polycyclic shape [10] and a serpentine worm-like shape [11,12], The thrombus shape may vary from one moment to the next as it may coil and uncoil [7,10], It appears as a free floating mass inside the right atrium moving quite often back and forth through the tricuspid valve during diastole [3], A thin attachment to the atrial wall may sometimes be seen [15]. Occasionally the thrombus may go back towards the infe rior vena cava or move entirely into the right ventricle [10,20], It may also be transiently trapped in the tricuspid valve or foramen ovale before moving towards the pulmo nary trunk [3], This migration from right heart to pulmo nary arteries has been described in exceptional observa tions [10,21], Several different views are necessary in order to appre ciate thrombus size, to analyze its position in regard to tight heart features and to distinguish between artifacts.…”

Multidetector row CT diagnosis of an infected right atrial thrombus following repeated dialysis catheter placement

“…On 2DE, RAT is seen as a randomly mobile echogenic focus, separate from the tricuspid valves and present in multiple planes [7,15]. The strength of 2DE lies in its low cost and real-time visualisation of thrombus.…”