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

• Published in: Hemodialysis international 2005-07, Vol.9 (3), p.236-240
• Main Authors: Van Laecke, S., Dhondt, A., De Sutter, J., Vanholder, R.
• Format: Article
• Language: English
• Subjects: Adult; atrium; catheter; Catheters, Indwelling - adverse effects; Coronary Thrombosis - diagnostic imaging; Coronary Thrombosis - etiology; Echocardiography, Transesophageal; Female; Heart Septal Defects, Atrial - complications; Hemodialysis; Humans; malfunctioning; patient foramen; Renal Dialysis - adverse effects; thrombus
• ISSN: 1492-7535; 1542-4758
• DOI: 10.1111/j.1492-7535.2005.01137.x

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.