Hickman catheters were introduced in the 1970s as long term central venous catheters for prolonged parenteral nutrition; their applications have been extended for the purpose of chemotherapy, bone marrow transplantation, and long term intravenous access for other reasons. The results of the use of Hickman catheters have been satisfactory, but complications are also common.
A right atrial thrombus was detected during routine echocardiograhic evaluation for anthracycline treatment in a 15 year old female patient with acute lymphoblastic leukaemia. She was treated with tissue plasminogen activator (t-PA) initially but underwent surgery because of an unsatisfactory response. She had a giant atrial thrombosis in her right atrium. The thrombus was successfully excised and the badly damaged endocardium was plicated to avoid recurrence.
This case illustrates the importance of placing the tip of catheter at the junction of the lower superior vena cava and right atrium in order to avoid endothelial damage.
Figure 1.
Giant right atrial thrombus in parasternal short axis view.