[Right intraventricular thrombus. Rare complication of caval catheterization].

Abstract

Background: Thrombus formation is one of the main complications of the catheterization used for total parenteral nutrition. Its location inside the right ventricle is exceptional. This paper describes such a case.

Case report: A boy was born at the gestational age of 35 weeks, weighing 2,640 g. He developed acute respiratory distress followed by prolonged diarrhea that required parenteral nutrition. A catheter was inserted into his right subclavian vein when he was aged 5 weeks. The patient developed septic shock with multi-visceral failure 8 days later. Blood cultures showed Staphylococcus aureus. Despite symptomatic therapy and antibiotics, the baby developed thrombosis of the superior vena cava with no right atrial thrombus, that required removal of the catheter. Angiography and Doppler echocardiography performed 2 and 3 weeks later showed a thrombus in the right ventricle that disappeared within 2 weeks after prolonged antibiotic and heparin therapy.

Conclusion: Repeated Doppler echocardiography is necessary to monitor prolonged total parenteral nutrition. Intracardiac thrombus can be detected; this is more frequently located in the atrium than in the ventricle.