Successful treatment of fungal right atrial thrombosis complicating central venous catheterization in a critically ill child.
A 9-year-old boy was admitted to our pediatric intensive care unit after multiple trauma. On the 17th day post trauma, he developed catheter-related sepsis with candidemia. After removal of the catheter and 6 days of unsuccessful intravenous antifungal therapy, conventional and transesophageal two-dimensional echocardiography was performed revealing a large right atrial thrombus. Surgical thrombectomy under cardiopulmonary bypass was performed and the patient recovered within a few days. Fungal right atrial thrombus is a rare, life-threatening complication of central venous catheterization. Two-dimensional echocardiography is a simple and effective diagnostic technique that should be performed when candidemia is detected. The proper therapeutic response depends on the findings of this examination. For a symptomatic patient with a large, mobile thrombus, we strongly recommend thrombectomy. Surgery not only allows removal of the mass and thus elimination of the mechanical complication but is also a key to management of infection.
Paut
O
O
Department of Pediatric Anesthesia and Intensive Care, La Timone University Hospital, Marseille, France.
Kreitmann
B
B
Silicani
M A
MA
Wernert
F
F
Broin
P
P
Viard
L
L
Camboulives
J
J
D002177:Candidiasis / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002648:Child; D016638:Critical Illness; D004452:Echocardiography; D006325:Heart Atria; D006331:Heart Diseases / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D006801:Humans; D008297:Male; D009104:Multiple Trauma / Q000150:complications; D017131:Thrombectomy; D013927:Thrombosis / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery