Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Echocardiography. 2021 Mar;38(3):435-439. doi: 10.1111/echo.14987. Epub 2021 Feb 1.
The development of right atrial (RA) thrombus (RAT) is a known complication of central venous catheter insertion (CVC). Deeper insertion of CVC within the RA may increase the risk for RAT development versus those placed at the superior vena cava (SVC)-RA junction. We sought to evaluate the incidence of catheter-associated RAT as detected by transthoracic echocardiograms (TTEs), characterize thrombi though multimodal imaging, and evaluate thrombi management with follow-up imaging.
A retrospective analysis was conducted of consecutive TTEs from our institution between October 1, 2018, and January 1, 2020, in which a venous catheter was visualized in the RA. Studies were reviewed in detail to determine the presence of suspected RAT. Demographic data, comorbidities, laboratory values, characteristics of the catheter and the thrombus, subsequent imaging and management, and outcomes were collected.
A total of 364 TTEs were performed in 290 patients with a venous catheter visualized in the RA. Of these 290 patients, 15 had an imaging suspicion for RAT yielding an incidence of 5.2%. Management strategies included anticoagulation in 13 (86.7%) patients and catheter removal in 11 (73.3%) patients. At eight months of follow-up, 11 (73.3%) patients had resolution of RAT based on subsequent imaging.
In patients with deeply placed CVC catheters, the incidental detection of RAT by TTE was not trivial. Anticoagulation and catheter removal and replacement, if deemed safe, were effective methods of thrombus management. RAT as a complication of CVCs must be accounted for when addressing factors that influence depth of CVC insertion.
右心房（RA）血栓（RAT）的形成是中央静脉导管插入（CVC）的已知并发症。RA 内 CVC 的更深插入可能会增加 RAT 发展的风险，而不是那些位于上腔静脉（SVC）-RA 交界处的 CVC。我们旨在通过经胸超声心动图（TTE）评估导管相关性 RAT 的发生率，通过多模态成像对血栓进行特征描述，并通过随访成像评估血栓的管理。
对 2018 年 10 月 1 日至 2020 年 1 月 1 日期间我院连续进行的 TTE 进行回顾性分析，其中在 RA 中观察到静脉导管。详细审查研究以确定疑似 RAT 的存在。收集人口统计学数据、合并症、实验室值、导管和血栓的特征、后续影像学和管理以及结果。
对 290 例在 RA 中可见静脉导管的患者进行了总共 364 次 TTE。在这 290 例患者中，有 15 例影像学怀疑有 RAT，发病率为 5.2%。管理策略包括抗凝治疗 13 例（86.7%）和导管拔除 11 例（73.3%）。在 8 个月的随访中，根据后续影像学检查，11 例（73.3%）患者的 RAT 得到缓解。
在 CVC 导管深度插入的患者中，TTE 偶然发现 RAT 并非微不足道。抗凝和导管拔除及更换，如果认为安全，是血栓管理的有效方法。在解决影响 CVC 插入深度的因素时，必须考虑 CVC 引起的 RAT 并发症。
