Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada.
Can Respir J. 2009 Sep-Oct;16(5):163-5. doi: 10.1155/2009/751507.
Central venous catheters (CVCs) are commonly used in clinical practice. One of the foremost complications associated with their use is the potential for symptomatic or asymptomatic thrombosis. CVC thrombosis, in turn, may not only result in vascular and catheter occlusion but also infection, pulmonary embolism, and formation of right heart thromboemboli. Thrombi within cardiac chambers are associated with an increased risk of mortality due to their potential for embolization to the pulmonary vasculature. We describe the case of a 77-year-old man, who was successfully thrombolyzed following detection of a right atrial thrombus and hemodynamically significant pulmonary embolism resulting from thrombus formation on the tip of a peripherally inserted central catheter (PICC). The present article is the first report of a PICC-related right atrial thrombus in an adult treated with thrombolysis. A systematic review of the literature suggests that the true incidence of this complication may be underestimated because the diagnosis may not be considered in asymptomatic and symptomatic patients, or may be missed by transthoracic echocardiography. The present case highlights the importance of maintaining a high index of suspicion for thromboembolic complications and heparin-induced thrombocytopenia in patients with CVCs or a PICC. It also underscores the important role of transesophageal echocardiography and thrombolysis in the diagnosis and management, respectively, of right heart thromboemboli with associated pulmonary embolism.
中心静脉导管（CVC）在临床实践中被广泛应用。其中一个最主要的并发症是潜在的有症状或无症状的血栓形成。CVC 血栓形成不仅会导致血管和导管阻塞，还会导致感染、肺栓塞和右心血栓形成。心室内的血栓由于其向肺血管栓塞的潜在风险，与死亡率增加有关。我们描述了一位 77 岁男性的病例，该患者在发现右心房血栓和由于外周插入的中心导管（PICC）尖端血栓形成导致的血流动力学显著的肺栓塞后，成功接受了溶栓治疗。本文首次报道了一例成人 PICC 相关的右心房血栓，该血栓通过溶栓治疗得到了治疗。文献系统回顾表明，由于在无症状和有症状患者中未考虑到该并发症的诊断，或者可能被经胸超声心动图漏诊，因此该并发症的真实发生率可能被低估了。本病例强调了在 CVC 或 PICC 患者中，对血栓栓塞并发症和肝素诱导的血小板减少症保持高度怀疑的重要性。它还突出了经食管超声心动图和溶栓治疗在诊断和管理右心血栓栓塞伴相关肺栓塞方面的重要作用。
