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Case Reports
. 2025 Aug 11:13:2050313X251365038.
doi: 10.1177/2050313X251365038. eCollection 2025.

Catheter-related right atrial thrombosis from malpositioned totally implantable venous access ports: Case series and preventive lessons

Yanshou Zhang  1 , Fangyi Sun  2 , Chao Yang  1 , Weina Wang  1 , Shuo Zhang  1 , Xiaolong Li  3 , Yunjiang Liu  1
Affiliations
Case Reports

Catheter-related right atrial thrombosis from malpositioned totally implantable venous access ports: Case series and preventive lessons

Yanshou Zhang et al. SAGE Open Med Case Rep. .

Abstract

Totally implantable venous access ports are widely used for long-term intravenous therapy in oncology patients. However, catheter malpositioning may result in catheter-related right atrial thrombosis, a rare but potentially life-threatening complication. We report three breast cancer patients who developed catheter-related right atrial thrombosis due to deeply located catheter tips within the mid-right atrium. All patients were successfully treated with systemic thrombolysis combined with anticoagulation, resulting in complete thrombus resolution. These cases underscore the preventable nature of catheter-related right atrial thrombosis through accurate intraoperative catheter tip localization using intracavitary electrocardiography or echocardiography and highlight the limitations of relying solely on postprocedural chest radiographs. Early recognition, precise localization, and individualized treatment are essential, but prevention remains the cornerstone of safe totally implantable venous access port utilization.

Keywords: anticoagulation therapy; catheter-related thrombosis; right atrial thrombosis; thrombolysis; totally implantable venous access port.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Chest X-rays showed the catheter tip is located at the level of the ninth posterior rib.
Figure 2.
Figure 2.
Transthoracic echocardiogram confirmed a large immobile mass in the right atrium, the size of mass was 3.4 × 2.5 cm.
Figure 3.
Figure 3.
Transthoracic echocardiogram confirmed thrombus resolution in the right atrium after the ninth day of thrombolytic therapy.
Figure 4.
Figure 4.
Chest X-rays showed the catheter tip is located at the level of the eighth posterior rib.
Figure 5.
Figure 5.
Transthoracic echocardiogram detected a right atrial thrombus measuring 1.4 × 1.3 cm.
Figure 6.
Figure 6.
Transthoracic echocardiogram confirmed thrombus resolution in the right atrium after the seventh day of thrombolytic therapy.
Figure 7.
Figure 7.
The chest X-ray shows the adjusted catheter tip is located at the seventh posterior rib.
Figure 8.
Figure 8.
Chest X-rays showed the catheter tip is located at the level of the eighth posterior rib.
Figure 9.
Figure 9.
Transthoracic echocardiogram detected a right atrial thrombus measuring 1.6 × 1.3 cm.
Figure 10.
Figure 10.
Transthoracic echocardiogram confirmed thrombus resolution in the right atrium after the ninth day of thrombolytic therapy.
Figure 11.
Figure 11.
The chest X-ray shows the adjusted catheter tip is located at the upper margin of the eighth posterior rib.
See this image and copyright information in PMC

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