Central venous catheter mechanical irritation of the right atrial free wall: A cause for thrombus formation

Thromboembolism is a major complication of long-term central venous catheter, usually associated with catheter or venous occlusion. Intracavitary right atrial thrombosis is currently considered to result from line-tip thrombosis extension. We report three adult patients in whom repeated mechanical trauma to the right atrial wall was probably the main mechanism. Transesophageal echocardiography revealed back and forth movement of the central catheter into a thrombus attached to the right atrial wall, thus suggesting a mechanism of catheter-associated thrombus formation, not previously visualized or suggested. Catheter removal and anticoagulation administration were undertaken with an uneventful clinical course and almost complete disappearance of the thrombi on transesophageal echocardiography follow-up.