Right Atrial Appendage Clot in Atrial Fibrillation Complicated by Pulmonary Thromboembolism: A Case Report

Authors

Qaem Cardiovascular Medical and Research Center, Mashhad Universityof Medical Sciences, Mashhad, Iran

Abstract

Nonvalvular atrial fibrillation (AF) can affect both right and left atria. Left atrial thrombus is more common in patients with nonvalvular AF. The presence of a large right atrial thrombus is a rare condition, which is seldom demonstrated as an etiology ofpulmonary embolism, especially without any deep vein thrombosis at the presence of only atrial fibrillation, as was observed in this case. Right atrial thrombus is an underdiagnosed entitywith a high mortality and morbidity rate. Therefore, right atrial appendage (RAA) and left atrial appendage assessmentsshould be consideredin patients with chronic nonvalvular AF.The best management modality has not yet been documented, and it sometimes resolved by anticoagulant therapy alone or neededsurgical removal. Here, we report a case of pulmonary thromboembolism with the complaints of coughing and blood-stained sputumwithout clinical or sonographic signs of deep vein thrombosis. Permanent AF rhythm and a large clot in RAA were detected as the sources for pulmonary embolism. We started anticoagulant therapy and the clot got smaller using a transesophageal echocardiogram as a diagnostic tool.

Keywords

References

  1. Bilge M, Eryonucu B, Güler N, Erkoç R. Right atrial appendage function in patients with chronic nonvalvular atrial fibrillation. Jpn Heart J. 2000;41(4):451-62. doi: 10.1536/jhj.41.451. [PubMed:11041096].
  2. Benjamin MM, Afzal A, Chamogeorgakis T, Feghali GA. Right atrial thrombus and its causes, complications and therapy. Proc (BaylUniv Med Cent). 2017;30(1):54-6.doi: 10.1080/ 08998280.2017.11929526. [PubMed:28127133].
  3. Flegel KM. When atrial fibrillation occurs with pulmonary embolism, is it the chicken or the egg? CMAJ. 1999; 160(8):1181- 2. [PubMed: 10234351].
  4. Lohani S, Tachamo N, Timilsina B, Nazir S. Pulmonary embolism and atrial fibrillation: a complicated Relationship. Int J Case Rep Images. 2017;8(6):376-9.doi: 10.5348/ijcri- 201751-cr-10790.
  5. Bashir M, Asher CR, Garcia MJ, Abdalla I, Jasper SE, Murray RD, et al. Right atrial spontaneous echo contrast and thrombi in atrial fibrillation: a transesophagealechocardiography study. J Am SocEchocardiogr. 2001;14(2):122-7. doi: 10.1067/mje. 2001.108668. [PubMed: 11174446].
  6.  deDivitiis M, Omran H, Rabahieh R, Rang B,Illien S, Schimpf R, et al. Right atrial appendage thrombosis in atrial fibrillation: its frequency and its clinical predictors. Am J Cardiol. 1999;84(9):1023-8. doi: 10.1016/s0002-9149(99)00492-0. [PubMed: 10569657].
  7.  Subramaniam B, Riley MF, Panzica PJ, Manning WJ.Transesophageal echocardiographic assessment of right atrial appendage anatomy and function: comparison with the left atrial appendage and implications for local thrombus formation. J Am SocEchocardiogr.     2006;19(4):429-33.   doi: 10.1016/j.echo.2005.10.013. [PubMed: 16581482].
  8.  Yasuoka Y, Naito J, Hirooka K, Chin W, Miyatake K, Kusuoka H, et al. Right atrial spontaneous echo contrast indicates a high incidence of perfusion defects in pulmonary scintigraphy in patients with atrial fibrillation. Heart Vessels. 2009;24(1):32- 6.doi: 10.1007/s00380-008-1084-3. [PubMed: 19165566].
  9. Ogren M, Berggvist D, Eriksson H, Lindblad B, Sternby NH. Prevalence and risk of pulmonary embolism in patients with intracardiac thrombosis: a population-based study of 23796 consecutive autopsies. Eur Heart J. 2005;26(11):1108-14. doi: 10.1093/eurheartj/ehi130.
Razavi International Journal of Medicine
Volume 7, Issue 2
April 2019
Pages 39-41

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