[Right atrial thrombosis with acute abdominal onset].
Intracardiac masses are detected more frequently due to the availability of echocardiography. Right atrial thrombosis is rare comparatively with that of the left atrium. The clinical presentation of the patient with right atrial thrombosis is linked with a misleading association between cardiovascular signs and digestive signs (acute abdominal pain, vomiting and marmorated skin of flanks). Initial clinical suspicions of acute pancreatitis, entero-mesenteric infarction and complicated gastro-duodenal ulcer were invalidated by imagistic investigations -- echocardiography and CT. The massive thrombus located in the right atrium, prolapsing during diastole through the tricuspid valve, was associated with the increase in plasmatic D-dimers and new ECG modifications type right bundle block (hemodynamic straining of the right ventricle). The evolution was favorable, after heparin-therapy by infusing pump, with relief of cardiovascular and digestive symptoms after the first 6 hours; after 36 h from the beginning of the treatment the thrombus was lysed. Sudden death likelihood through complete obstruction of the tricuspid ostium was prevented due to the early diagnosis offered by imagistic methods.
Petcu
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Universitatea de Medicină şi Farmacie Craiova. Petrus_Dorel.Petcu@yahoo.com
Petcu
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Roşu
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D000006:Abdomen, Acute / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D004452:Echocardiography; D004562:Electrocardiography; D006325:Heart Atria; D006331:Heart Diseases / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D013927:Thrombosis / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D016896:Treatment Outcome
D000925:Anticoagulants; D006493:Heparin