Right atrial thrombus in an asymptomatic hemodialysis patient with malfunctioning catheter and patent foramen ovale

Nephrology Section of Department of Internal Medicine, University of Ghent, Ghent, Belgium.
Hemodialysis International (Impact Factor: 1.24). 08/2005; 9(3):236-40. DOI: 10.1111/j.1492-7535.2005.01137.x
Source: PubMed


The creation of an accurate functioning arteriovenous fistula has been a long-lasting problem in the hemodialysis setting. In spite of recent guidelines and largely because of the old age of the current dialysis population and a high incidence of diabetes mellitus, atherosclerosis, and related vascular problems, it is not always possible to create an adequate fistula. In that case, long-term tunneled indwelling central vein catheters are a frequently used alternative. Of the many possible complications related to venous access in hemodialysis patients, catheter dysfunction is the most prevalent. We report a 23-year-old female hemodialysis patient in whom such malfunctioning was followed by echocardiography that revealed a large right atrial thrombus (RAT) in close contact to the tip of a long-term indwelling catheter in the presence of a patent foramen ovale. Although RAT is a rare complication in hemodialysis patients, it has very specific therapeutic implications. The present patient underwent a successful surgical atrial thrombectomy. Our experience underscores that in cases of malfunctioning catheter, echocardiographic screening is mandatory.

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    • "In suspected cases, TEE can be done and TEE has a better sensitivity and specificity compared to TTE [7]. Cardiac MRI with gadolinium contrast can be a useful tool for diagnosis and for tissue characterization but was avoided in our case because of risk of nephrogenic systemic fibrosis [8]. "
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