624 Surgical Management of Right Atrial Mass Associated With a Vascular Access Catheter

Abstract

Atrial masses are a serious clinical problem. The authors report a case of an atrial mass associated with a vascular access catheter. An immunosuppressed 18-year-old female with Lupus Nephritis was referred to hospital after a large echogenic mass was identified in the right atrium at the tip of a vascular access catheter (Panel A). Investigation was negative for infective endocarditis. Percutaneous catheter removal was deemed high risk due to potential embolisation. Anticoagulation was initiated for suspected thrombus and catheter removal was planned after serial imaging. She represented with fevers three weeks later. Blood cultures demonstrated Stenotrophomonas maltophilia. After multidisciplinary review, the decision was made to pursue open surgical thrombectomy and vascular catheter removal. Surgery was performed with no complications (Panel B). Histology demonstrated thrombus with no evidence of endocarditis or myxoma. Atrial masses can pose a diagnostic and management challenge. The differentials include tumours, infection and thrombi. Atrial thrombi complicate 5% of vascular catheters in haemodialysis patients. (1) In 50% of cases, therapeutic anticoagulation is the treatment of choice. Primary surgical thrombectomy occurs in 25% of patients while first line thrombolysis happens in 7-17%. (2,3) In those with contraindications to anticoagulation, thrombus size of greater than 6cm and with another indication for surgery (e.g. infective endocarditis), a primary surgical strategy may be preferred.