Catheter-related atrial thrombosis in a patient with recent cerebral haemorrhage: to treat or not to treat?

Abstract

We report on the case of a 43-year-old Indian man, brought to the emergency department (ED) because of traumatic brain injury due to a motorcycle crash. In the ED, the patient was awake, and haemodynamically stable. The neurological examination did not reveal any abnormality. All standard blood tests were normal. A brain computed tomography (CT scan) showed blood leakage on cortical insular and frontal furrows, temporo-parietal subdural haematoma, and a left occipital skull fracture. As the neurosurgeon suggested a conservative approach, the patient was transferred first to an ICU, then to our unit. Over the next few days, he became pyretic, and therefore the central venous catheter was removed. The catheter’s tip cultures eventually were positive for Staphylococcus epidermidis. A transthoracic echocardiogram (TTE) showed a right atrial mass (Fig. 1), which was determined to be an atrial thrombus on a transesophageal echocardiogram (TEE) and cardiac magnetic resonance imaging (MRI). Cautious anticoagulant therapy with low-molecular weight heparin was started, along with close clinical and radiological observation to detect any subtle haemorrhagic complications. After 20 days of effective anticoagulation, a TTE showed no evidence for atrial thrombi (Fig. 1). Discussion