title: Massive catheter-related thrombosis of vena cava superior protruding into the right atrium in a hemodialysis patient.
abstract: A 36-year-old man with chronic renal insufficiency secondary to type 1 diabetes mellitus was on hemodialysis via central venous catheter (CVC), newly placed into the right subclavian vein after his arteriovenous fistula became dysfunctional. Seven days after CVC insertion, the patient developed fever and on day 11 echocardiography showed a large nearly occluding thrombus in the superior vena cava (SVC) extending into the right atrium (RA). Emergency surgical thrombectomy was successfully performed and an 11 cm long thrombus extending from the RA cranially into the SVC occupying majority of the vein's lumen was removed. Cultures from the thrombus and CVC were negative, but polymerase chain reaction was positive for Staphylococcus aureus. This particular case was interesting for a marked discrepancy between large SVC occluding thrombosis and a relatively mild clinical presentation with fever, and it highlights the importance of correct timing of echocardiography exam which might prevent potentially fatal consequences such as pulmonary embolism.
authors: International Clinical Research Centre, St. Anne's University Hospital Brno, Brno, Czech Republic.
authors: Lukas
authors: L
authors: Mach
authors: Centre of Cardiovascular Surgery and Transplantation Brno, Brno, Czech Republic.
authors: Olga
authors: O
authors: Ondruskova
authors: International Clinical Research Centre, St. Anne's University Hospital Brno, Brno, Czech Republic.|Centre of Cardiovascular Surgery and Transplantation Brno, Brno, Czech Republic.
authors: Petr
authors: P
authors: Nemec
authors: International Clinical Research Centre, St. Anne's University Hospital Brno, Brno, Czech Republic.|Centre of Cardiovascular Surgery and Transplantation Brno, Brno, Czech Republic.
authors: Marek
authors: M
authors: Orban
mesh_terms: D000328:Adult; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D004452:Echocardiography; D006325:Heart Atria / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D006435:Renal Dialysis / Q000009:adverse effects*; D013927:Thrombosis / Q000150:complications*
keywords: Central venous catheter; hemodialysis; thrombosis