A Long Right Atrial Thrombus Intermittently Prolapsing into Right Ventricle in a Patient with Recurrent Ischemic Stroke: An Image Report
Affiliation(s)
Department of Medicine, MedStar Harbor Hospital, Baltimore, USA. Department of Medicine, MedStar Harbor Hospital, Baltimore, USA Division of Cardiology, MedStar Harbor Hospital, Baltimore, USA. Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, USA.
Department of Medicine, MedStar Harbor Hospital, Baltimore, USA. Department of Medicine, MedStar Harbor Hospital, Baltimore, USA Division of Cardiology, MedStar Harbor Hospital, Baltimore, USA. Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, USA.
ABSTRACT
A 39-year-old male was admitted for recurrent ischemic strokes. TEE was performed to detect the potential intra-cardiac thrombi and right-to-left shunts. A large hypermobile, echodense, irregular mass was found in the right atrium, which looked like a cluster of grapes. The motion of the components of the mass was synchronized, prolapsing into right ventricle in an octopus-like fashion during diastole. There was no evidence for PFO or other intra-cardiac shunts by color flow Doppler. The patient was referred to surgery and a continuous 30 cm long thrombus spanning from the inferior vena cava to the right ventricle was discovered.
Cite this paper
Liu, Z. , Malik, S. , Gammie, J. and Rosen, B. (2014) A Long Right Atrial Thrombus Intermittently Prolapsing into Right Ventricle in a Patient with Recurrent Ischemic Stroke: An Image Report. Case Reports in Clinical Medicine, 3, 309-313. doi: 10.4236/crcm.2014.35068.
Liu, Z. , Malik, S. , Gammie, J. and Rosen, B. (2014) A Long Right Atrial Thrombus Intermittently Prolapsing into Right Ventricle in a Patient with Recurrent Ischemic Stroke: An Image Report. Case Reports in Clinical Medicine, 3, 309-313. doi: 10.4236/crcm.2014.35068.
References
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http://dx.doi.org/10.1016/j.nrl.2011.05.010 [11] Droste, D.W., et al. (2004) Right-to-Left-Shunts Detected by Transesophageal Echocardiography and Transcranial Doppler Sonography. Cerebrovasc Disease, 17, 191-196.
http://dx.doi.org/10.1159/000075790 [12] Rose, P.S., Punjabi, N.M. and Pearse, D.B. (2002) Treatment of Right Heart Thromboemboli. Chest, 121, 806-814.
http://dx.doi.org/10.1378/chest.121.3.806 [13] Pierre-Justin, G. and Pierard, L.A. (2005) Management of Mobile Right Heart Thrombi: A Prospective Series. International Journal of Cardiology, 99, 381-388.
http://dx.doi.org/10.1016/j.ijcard.2003.10.071 [14] Torbicki, A., et al. (2003) Right Heart Thrombi in Pulmonary Embolism: Results from the International Cooperative Pulmonary Embolism Registry. Journal of the American College of Cardiology, 41, 2245-2251.
http://dx.doi.org/10.1016/S0735-1097(03)00479-0 [15] Ruel, M., et al. (2001) Resection of Right Atrial Tumor Thrombi without Circulatory Arrest. The Annals of Thoracic Surgery, 71, 733-734.
http://dx.doi.org/10.1016/S0003-4975(00)02317-1 [16] Cale, R., et al. (2008) Giant Left Atrial Mass: Thrombus Mimicking Myxoma. Revista Portuguesa de Cardiologia, 27, 1191-1194.
[1] Lam, K.Y., Dickens, P. and Chan, A.C. (1993) Tumors of the Heart. A 20-Year Experience with a Review of 12,485 Consecutive Autopsies. Archives of Pathology & Laboratory Medicine, 117, 1027-1031. [2] Chitwood Jr., W.R. (1988) Cardiac Neoplasms: Current Diagnosis, Pathology, and Therapy. Journal of Cardiac Surgery, 3, 119-154.
http://dx.doi.org/10.1111/j.1540-8191.1988.tb00232.x [3] Aksu, T., et al. (2008) Thrombi in the Right Atrium and Inferior Vena Cava Mimicking Myxoma in a Patient with Recurrent Pulmonary Thromboembolism. Turk Kardiyoloji Dernegi Arsivi, 36, 555-557. [4] Delange Segura, L. (2005) Limitations of Transesophageal Ultrasound in the Assessment of Intracardiac Masses: A Case Report. ta Española de Anestesiología y Reanimación, 52, 421-424. [5] Farfel, Z., et al. (1987) Review of Echocardiographically Diagnosed Right Heart Entrapment of Pulmonary Emboli-in-Transit with Emphasis on Management. American Heart Journal, 113, 171-178.
http://dx.doi.org/10.1016/0002-8703(87)90026-3 [6] Betrian Blasco, P., et al. (2008) Three-Dimensional Imaging of Redundant Chiari’s Network Prolapsing into Right Ventricle. Journal of the American Society of Echocardiography, 21, 188e1-188e2. [7] Wertman, B.M., et al. (2008) Right Atrial and Ventricular Masses of Unknown Origin. Journal of the American Society of Echocardiography, 21, 776e5-776e7. [8] Siddiqui, M.A., Holmberg, M.J. and Khan, I.A. (2001) Spontaneous Echo Contrast in Left Atrial Appendage during Sinus Rhythm. Texas Heart Institute Journal, 28, 322-323. [9] Harvey, J.R., et al. (1986) Clinically Silent Atrial Septal Defects with Evidence for Cerebral Embolization. Annals of Internal Medicine, 105, 695-697. http://dx.doi.org/10.7326/0003-4819-105-5-695 [10] Martinez-Sanchez, P., et al. (2012) Low Sensitivity of the Echocardiograph Compared with Contrast Transcranial Doppler in Right-to-Left Shunt]. Neurologia, 27, 61-67.
http://dx.doi.org/10.1016/j.nrl.2011.05.010 [11] Droste, D.W., et al. (2004) Right-to-Left-Shunts Detected by Transesophageal Echocardiography and Transcranial Doppler Sonography. Cerebrovasc Disease, 17, 191-196.
http://dx.doi.org/10.1159/000075790 [12] Rose, P.S., Punjabi, N.M. and Pearse, D.B. (2002) Treatment of Right Heart Thromboemboli. Chest, 121, 806-814.
http://dx.doi.org/10.1378/chest.121.3.806 [13] Pierre-Justin, G. and Pierard, L.A. (2005) Management of Mobile Right Heart Thrombi: A Prospective Series. International Journal of Cardiology, 99, 381-388.
http://dx.doi.org/10.1016/j.ijcard.2003.10.071 [14] Torbicki, A., et al. (2003) Right Heart Thrombi in Pulmonary Embolism: Results from the International Cooperative Pulmonary Embolism Registry. Journal of the American College of Cardiology, 41, 2245-2251.
http://dx.doi.org/10.1016/S0735-1097(03)00479-0 [15] Ruel, M., et al. (2001) Resection of Right Atrial Tumor Thrombi without Circulatory Arrest. The Annals of Thoracic Surgery, 71, 733-734.
http://dx.doi.org/10.1016/S0003-4975(00)02317-1 [16] Cale, R., et al. (2008) Giant Left Atrial Mass: Thrombus Mimicking Myxoma. Revista Portuguesa de Cardiologia, 27, 1191-1194.