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Review
. 2024 Nov 5;13(22):6630.
doi: 10.3390/jcm13226630.

Over-the-Wire Retrieval of Infectious Hemodialysis Catheter-Related Right Atrial Thrombus Causing Recurrent Pleural Empyema and Sepsis: A Case-Based Review

Giuseppe Barilaro  1 , Amedeo Galassi  1 , Maria Chiara Gatto  2 , Giulia Ciocci  1 , Fabrizia Paola Fabrizio  1 , Alessandra Cappelli  1
Affiliations
Review

Over-the-Wire Retrieval of Infectious Hemodialysis Catheter-Related Right Atrial Thrombus Causing Recurrent Pleural Empyema and Sepsis: A Case-Based Review

Giuseppe Barilaro et al. J Clin Med. .

Abstract

Introduction: Infectious catheter-related right atrial thrombus (CRAT) is a potentially fatal but often underestimated contingency associated with central venous catheter (CVC) in patients on hemodialysis. Management guidelines for CRAT are lacking, and its occurrence poses clinical challenges. Here, we describe the case of an infectious CRAT in a young patient on hemodialysis with peculiar clinical complications and perform a literature review. Case presentation and literature review: A 30-year-old man on hemodialysis after bilateral nephrectomy due to polycystic disease presented with hyperpyrexia resistant to broad-spectrum antibiotics. A pleural empyema caused by methicillin-resistant Staphylococcus aureus (MRSA) was diagnosed. Since fever persisted despite targeted antibiotic therapy, a transthoracic echocardiogram to exclude infective endocarditis was performed, showing a right atrial thrombus. CVC was promptly removed and the thrombus was aspirated through a percutaneous retrieval system. The thrombus cultural exam resulted positive for MRSA. After performing an extensive literature review, we could not find another case reporting the concomitance of these two rare complications. Conclusions: CRAT is a life-threatening complication in hemodialysis patients. While various treatment options exist, evidence-based guidelines are lacking, leading to individualized management strategies. Minimizing CVC use remains the best option for preventing such a complication.

Keywords: catheter-related right atrial thrombus; methicillin-resistant Staphylococcus aureus (MRSA); percutaneous thrombectomy; pleural empyema.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The admission chest CT scan shows a massive right pleural empyema (a) with pulmonary infiltrates (b).
Figure 2
Figure 2
Pre-procedure transesophageal echocardiogram (TEE) showing a thrombus attached to the right atrium free wall.
Figure 3
Figure 3
The extracted mass, with a maximum diameter of three centimeters, has a cauliflower-like shape with a prominent thrombotic component.
See this image and copyright information in PMC

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