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Case Reports
. 2024 May 25;16(5):e61046.
doi: 10.7759/cureus.61046. eCollection 2024 May.

Thrombus Tango: Hypercoagulable State With a Right Atrial Mass and Superimposed Persistent Bacteremia

Oshin Rai  1 , Anvit D Reddy  1 , Natalie Shaykh  1 , Niyati Patel  2 , Vanshika Tripathi  1 , Ghania Masri  1
Affiliations
Case Reports

Thrombus Tango: Hypercoagulable State With a Right Atrial Mass and Superimposed Persistent Bacteremia

Oshin Rai et al. Cureus. .

Abstract

Bacillus cereus is an uncommon nosocomial bacteria, typically dismissed as a contaminant. This case is a unique scenario in which B. cereus bacteremia persisted despite appropriate treatment. Further investigation revealed the presence of a right atrial thrombus believed to harbor a biofilm responsible for the sustained bacteremia. Clearance of the thrombus using the AngioVac system (AngioDynamics, Inc., Latham, NY) led to the resolution of blood cultures, and subsequently, the patient was discharged with a six-week course of intravenous (IV) antibiotics.

Keywords: angio vac; bacillus cereus; gram positive bacteremia; pulmonary emboli; right atrium thrombus.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Computed tomography of the chest with pulmonary embolism protocol (CTA PE)
The images show (A) right lower lobe posterior basilar segmental and subsegmental and (B) left upper lobe anterior segmental and subsegmental pulmonary emboli.
Figure 2
Figure 2. Transthoracic echocardiogram (TTE) image
The yellow arrow shows a 2.6 cm by 1.5 cm right atrial mass without clear valvular vegetations.
Figure 3
Figure 3. Cardiac magnetic resonance imaging (cMRI) images
Cardiac magnetic resonance imaging (cMRI) revealed a right atrial peripherally hypointense lesion measuring 2.6 cm x 2.3 cm x 0.9 cm, with a gray etched core close to the crista terminalis and homogeneous low signal.
Figure 4
Figure 4. Transesophageal echocardiogram (TEE) image
The image shows an irregularly shaped right atrial 2.6 cm x 2.3 cm x 1.0 cm (anterior-posterior, transverse, craniocaudal) peripherally hypointense lesion with a gray etched core close to the crista terminalis. On phase-sensitive inversion recovery sequence, the entire lesion demonstrates homogeneous low signal compatible with thrombus. There is no lesional contrast enhancement.
Figure 5
Figure 5. Susceptibility testing report done through broth microdilution
See this image and copyright information in PMC

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