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Unusual complication of central venous catheter detected on contrast-enhanced EUS (with video)


1 Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
3 Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
4 Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Date of Submission16-Jan-2022
Date of Acceptance24-Apr-2022
Date of Web Publication05-Oct-2022

Correspondence Address:
Surinder Singh Rana,
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/EUS-D-22-00018



How to cite this URL:
Mahajan G, Bhasin D, Telaprolu H, Asthul A, Gupta R, Rana SS. Unusual complication of central venous catheter detected on contrast-enhanced EUS (with video). Endosc Ultrasound [Epub ahead of print] [cited 2022 Nov 28]. Available from: http://www.eusjournal.com/preprintarticle.asp?id=357885

A 50-year-old woman presented with severe upper abdominal pain. She was diagnosed with gallstone-related acute pancreatitis with acute lung injury. She was managed in the intensive care unit, and a central venous catheter (CVC) was inserted in the right internal jugular vein for hemodynamic assessment. Two weeks later, she developed fever and imaging revealed multiple acute necrotic collections (ANCs). EUS-guided transluminal drainage was not done as ANCs were ill-defined with partially formed enclosing wall. However, EUS revealed an oscillating echogenic mass lesion in the right atrium [[Figure 1]; arrows]. Contrast-enhanced-EUS performed after intravenous injection of 2.4 ml of SonoVue (Bracco, Milan, Italy) microbubble contrast followed by a 10-ml push of normal saline and using low mechanical index revealed the echogenic lesion to be nonenhancing suggestive of a thrombus [Figure 2] and [Video 1 [Additional file 1]]. Transthoracic echocardiography (TTE) confirmed the presence of an echogenic, mobile thrombus in the right atrium [[Figure 3]; arrow]. The patient was started on therapeutic anticoagulation, and the CVC catheter was not used but left in situ. TTE done 2 weeks later revealed a reduction in the size and a decrease in echogenicity of the thrombus [[Figure 4]; arrow]. TTE done 4 weeks later revealed a marked reduction in the size of the thrombus, and the CVC was removed uneventfully. The patient is asymptomatic on oral anticoagulation.
Figure 1: EUS: Oscillating echogenic mass lesion in the right atrium

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Figure 2: Contrast EUS: Nonenhancing echogenic lesion in the right atrium suggestive of a thrombus

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Figure 3: TTE: Echogenic, mobile thrombus in the right atrium. TTE: Transthoracic echocardiography

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Figure 4: TTE done 2 weeks later: Revealed a reduction in size and a decrease in echogenicity of the thrombus. TTE: Transthoracic echocardiography

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CVC-associated right atrial thrombus is a potentially serious complication and can cause serious complications such as pulmonary embolism, infection, or septic emboli.[1] The damage to the right atrial endothelial wall by the moving tip predisposes to thrombus formation.[2] The thrombus appears like an echogenic mass in the right atrium, and contrast echocardiography or EUS by demonstrating the absence of flow in the mass can differentiate a thrombus from other causes of right atrial mass.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

Surinder Singh Rana is an Editorial Board Member of the journal. This article was subject to the journal's standard procedures, with peer review handled independently of the editor and his research group.



 
  References Top

1.
Verso M, Agnelli G. Venous thromboembolism associated with long-term use of central venous catheters in cancer patients. J Clin Oncol 2003;21:3665-75.  Back to cited text no. 1
    
2.
Vesely TM. Central venous catheter tip position: A continuing controversy. J Vasc Interv Radiol 2003;14:527-34.  Back to cited text no. 2
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

 
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