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Right atrial thrombus detected by two-dimensional echocardiography after acute pulmonary embolism
AugustI. 1984
THE AMERICAN JOURNAL OF CARDIOLOGY Volume 54
407
Right Atrial Thrombus Detected by Two-Dimensional Echocardiography After Acute Pulmonary Embolism PAOLD SPIRITO, MD PAOLO BELLOTTI, MD FRANCESC’O CHIARELLA, MD SALVATOFIE SPAGNOLO, MD CARLO VECCHIO, MD
Although its value is well established in detecting left atria1 and left ventricular thrombi,Q 2-dimensional echocardiography (2-D echo) is not often used to diagnose right-sided cardiac thrombi.34 Such was the case in the patient described herein. A 62-year-old woman with varicose veins and a history of recurrent phlebitis was admitted 12 hours after sudden onset of dyspnea. She was mildly dyspneic. The blood pressure was 90160 mm Hg and the heart rate was 110 beatslmin. The chest radiograph was normal. The electrocardiogram showed negative T waves in the precordial leads. Blood gas analysis showed mild hypoxia and respiratory alkalosis. A 2-D echocardiogram wasperformed, which showed a diluted right ventricle, paradoxical septal motion and a large, pedunculated right atria1 mass, which prolapsed through the tricuspid valve orifice into the right ventricle during diastole (Fig. 1). The mass appea.red to be continuous with the wall of the right atrium in the area of the inferior vena cava. Emergency cardiac surgery was performed immediately and a 1 X 5 cm, sausage-shaped thrombus, projecting from the inferior vena cava into the right atrium, was removed. Two slightly smaller thrombi also were removed from the pulmonary trunk. The postoperative course was uneventful. A month later, echo showe’d a normal-sized right ventricle.
Only a few patients have been described with rightsided cardiac thrombi identified by 2-D echo.34 Our case study shows that !insome patients with acute pulmonary embolism, 2-ID echo may detect right-sided cardiac thrombi, not yet mobilized to the lungs, and may warrant emergency su:rgical treatment. References 1. Skestha NK, MorenoFL, NM&O FV, TorreaL, CalleJaHB. Twodiiional echocardiographicdiagnosisof left atrial thrombusin rheumaticheart disease. A clinicopathologlcstMy. Circulation1983;67:341-347.
FromtheDepartment ofCardiology, Ente Ospedaliero Ospedali Galliera, Via Volta8, Genoa,Italy;andtheDepartment of Cardiac Surgery, OS pedaleS. Madno, Viale BanedettoXV, Genoa,Italy.Manuscript receivedFebruary 23, 1984; revised manuscript received April 8, 1984, acceptedApril9,1984.
FIGURE 1. Sequential Sdimensional echocardiographic stop-frame images (with schematic illustrations) obtained in the right ventricular apical 2-chamber view. A, a pedunculated, large right atrial thrombus, continuous with the wall of the right atrium in the area of the inferior vena cava. B and C, during the cardiac cycle the thrombus prolapses through the tricuspid valve orifice into the right ventricle. RA = right atrium; RV = right ventricle; T = thrombus.
2. Stratton JR, LipMy - _ GW Jr, Pearlman AS, Ritchk Jf.. Detectii of left ventricular thrombusby two-dimensionalechocardiography: sensltlvity.spacificitv and causes of uncertaintv.Circulation1982:66:156-166. 3. Mark By, Panldfs IP, Koll& MN, Mlnlz GS, daes J. Twodimenslonsl ;;;$ographlc detectionof rightatrial thrombl.Am J Cardiol 1963;51: 4. Cams PC’.Transknt rightatrialthrombusduringacute myocardialinfarction: diagnosisby echocardlography.Am J Cardlol 1983;51:1228-1229. 5. Radish GA, Anderson AL. Echocardiographicdiagnosis of right atrial thromboembollsm.J Am Coll Cardiol 1983;1:1167-1169. 6. Stowers SA, L&off RH, Waswnnan A$ Katz RJ. Bran GB, Hsu I. Right ventricular lhrombus formation in assoctadonwith acute myocardial infarction: diagnosis by Sdimensional echocardiography.Am J Cardlol 1983;52:912-913.
CORRECTION
In the May l&l984 issue on page 1454 (Honorary mention: Platypnoea and Interatrial Right-to-Left Shunting After Lobectomy [R.M. Springer et al]), the name C.S. Simon is incorrect. It is C. Simon Chakko.
THE AMERICAN JOURNAL OF CARDIOLOGY Volume 54
407
Right Atrial Thrombus Detected by Two-Dimensional Echocardiography After Acute Pulmonary Embolism PAOLD SPIRITO, MD PAOLO BELLOTTI, MD FRANCESC’O CHIARELLA, MD SALVATOFIE SPAGNOLO, MD CARLO VECCHIO, MD
Although its value is well established in detecting left atria1 and left ventricular thrombi,Q 2-dimensional echocardiography (2-D echo) is not often used to diagnose right-sided cardiac thrombi.34 Such was the case in the patient described herein. A 62-year-old woman with varicose veins and a history of recurrent phlebitis was admitted 12 hours after sudden onset of dyspnea. She was mildly dyspneic. The blood pressure was 90160 mm Hg and the heart rate was 110 beatslmin. The chest radiograph was normal. The electrocardiogram showed negative T waves in the precordial leads. Blood gas analysis showed mild hypoxia and respiratory alkalosis. A 2-D echocardiogram wasperformed, which showed a diluted right ventricle, paradoxical septal motion and a large, pedunculated right atria1 mass, which prolapsed through the tricuspid valve orifice into the right ventricle during diastole (Fig. 1). The mass appea.red to be continuous with the wall of the right atrium in the area of the inferior vena cava. Emergency cardiac surgery was performed immediately and a 1 X 5 cm, sausage-shaped thrombus, projecting from the inferior vena cava into the right atrium, was removed. Two slightly smaller thrombi also were removed from the pulmonary trunk. The postoperative course was uneventful. A month later, echo showe’d a normal-sized right ventricle.
Only a few patients have been described with rightsided cardiac thrombi identified by 2-D echo.34 Our case study shows that !insome patients with acute pulmonary embolism, 2-ID echo may detect right-sided cardiac thrombi, not yet mobilized to the lungs, and may warrant emergency su:rgical treatment. References 1. Skestha NK, MorenoFL, NM&O FV, TorreaL, CalleJaHB. Twodiiional echocardiographicdiagnosisof left atrial thrombusin rheumaticheart disease. A clinicopathologlcstMy. Circulation1983;67:341-347.
FromtheDepartment ofCardiology, Ente Ospedaliero Ospedali Galliera, Via Volta8, Genoa,Italy;andtheDepartment of Cardiac Surgery, OS pedaleS. Madno, Viale BanedettoXV, Genoa,Italy.Manuscript receivedFebruary 23, 1984; revised manuscript received April 8, 1984, acceptedApril9,1984.
FIGURE 1. Sequential Sdimensional echocardiographic stop-frame images (with schematic illustrations) obtained in the right ventricular apical 2-chamber view. A, a pedunculated, large right atrial thrombus, continuous with the wall of the right atrium in the area of the inferior vena cava. B and C, during the cardiac cycle the thrombus prolapses through the tricuspid valve orifice into the right ventricle. RA = right atrium; RV = right ventricle; T = thrombus.
2. Stratton JR, LipMy - _ GW Jr, Pearlman AS, Ritchk Jf.. Detectii of left ventricular thrombusby two-dimensionalechocardiography: sensltlvity.spacificitv and causes of uncertaintv.Circulation1982:66:156-166. 3. Mark By, Panldfs IP, Koll& MN, Mlnlz GS, daes J. Twodimenslonsl ;;;$ographlc detectionof rightatrial thrombl.Am J Cardiol 1963;51: 4. Cams PC’.Transknt rightatrialthrombusduringacute myocardialinfarction: diagnosisby echocardlography.Am J Cardlol 1983;51:1228-1229. 5. Radish GA, Anderson AL. Echocardiographicdiagnosis of right atrial thromboembollsm.J Am Coll Cardiol 1983;1:1167-1169. 6. Stowers SA, L&off RH, Waswnnan A$ Katz RJ. Bran GB, Hsu I. Right ventricular lhrombus formation in assoctadonwith acute myocardial infarction: diagnosis by Sdimensional echocardiography.Am J Cardlol 1983;52:912-913.
CORRECTION
In the May l&l984 issue on page 1454 (Honorary mention: Platypnoea and Interatrial Right-to-Left Shunting After Lobectomy [R.M. Springer et al]), the name C.S. Simon is incorrect. It is C. Simon Chakko.