Intensive Care Med DOI 10.1007/s00134-015-3715-3
Matteo Parotto Marjan Jariani Duminda Wijeysundera Massimiliano Meineri
IMAGING IN INTENSIVE CARE MEDICINE
Early thrombus formation on a pulmonary artery catheter
Received: 20 February 2015 Accepted: 24 February 2015 Ó Springer-Verlag Berlin Heidelberg and ESICM 2015 M. Parotto ()) M. Jariani D. Wijeysundera M. Meineri Department of Anesthesia and Pain Management, Toronto General Hospital, 200 Elizabeth Street EN3-432, Toronto, ON M5G 2C4, Canada e-mail: [email protected] Tel.: ?1 416 340 3567 M. Parotto M. Jariani D. Wijeysundera M. Meineri University of Toronto, Toronto, ON, Canada D. Wijeysundera Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
Fig. 1 a 2D and b 3D mid-esophageal bicaval views of TEE images showing a thrombus (asterisk) in the RA attached to the PAC. 2D two dimensional, 3D three dimensional, PAC pulmonary
A 42-year-old woman presented for replacement of a failing mechanical mitral valve prosthesis. After induction of anesthesia, endotracheal intubation, and real-time ultrasound-guided insertion of a right internal jugular vein sheath, a non-heparin-coated pulmonary artery catheter (PAC) was uneventfully inserted. A complete baseline transesophageal echocardiography (TEE) revealed a large independently mobile filamentous mass in the right atrium (RA), attached to the PAC (Fig. 1a), consistent with fresh thrombus. 2D/3D images in several planes confirmed the findings (Fig. 1b). Cardiopulmonary bypass was instituted after full heparinization and surgery was uneventful. After weaning from cardiopulmonary bypass, follow-up TEE showed no evidence of RA mass on the PAC. Postoperatively, the patient was transferred to the intensive care unit as planned. The PAC was removed on postoperative day 1. The patient’s recovery was uneventful.
artery catheter, TEE transesophageal echocardiography, RA right atrium, LA left atrium, SVC superior vena cava, IVC inferior vena cava
The risks associated with PACs are well known. Although the incidence of thromboembolic complications is increased with PAC monitoring for longer periods of time, thrombi have been noted attached to PACs within 1–2 h after insertion. Our case suggests early thrombus formation (within minutes) on a newly inserted PAC. One should be aware of such potential
complications when considering PAC insertion, even for brief periods. Conflicts of interest On behalf of all authors, the corresponding author states that there is no conflict of interest. Informed consent patient.
Consent for publication was obtained from the
Matteo Parotto Marjan Jariani Duminda Wijeysundera Massimiliano Meineri
IMAGING IN INTENSIVE CARE MEDICINE
Early thrombus formation on a pulmonary artery catheter
Received: 20 February 2015 Accepted: 24 February 2015 Ó Springer-Verlag Berlin Heidelberg and ESICM 2015 M. Parotto ()) M. Jariani D. Wijeysundera M. Meineri Department of Anesthesia and Pain Management, Toronto General Hospital, 200 Elizabeth Street EN3-432, Toronto, ON M5G 2C4, Canada e-mail: [email protected] Tel.: ?1 416 340 3567 M. Parotto M. Jariani D. Wijeysundera M. Meineri University of Toronto, Toronto, ON, Canada D. Wijeysundera Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
Fig. 1 a 2D and b 3D mid-esophageal bicaval views of TEE images showing a thrombus (asterisk) in the RA attached to the PAC. 2D two dimensional, 3D three dimensional, PAC pulmonary
A 42-year-old woman presented for replacement of a failing mechanical mitral valve prosthesis. After induction of anesthesia, endotracheal intubation, and real-time ultrasound-guided insertion of a right internal jugular vein sheath, a non-heparin-coated pulmonary artery catheter (PAC) was uneventfully inserted. A complete baseline transesophageal echocardiography (TEE) revealed a large independently mobile filamentous mass in the right atrium (RA), attached to the PAC (Fig. 1a), consistent with fresh thrombus. 2D/3D images in several planes confirmed the findings (Fig. 1b). Cardiopulmonary bypass was instituted after full heparinization and surgery was uneventful. After weaning from cardiopulmonary bypass, follow-up TEE showed no evidence of RA mass on the PAC. Postoperatively, the patient was transferred to the intensive care unit as planned. The PAC was removed on postoperative day 1. The patient’s recovery was uneventful.
artery catheter, TEE transesophageal echocardiography, RA right atrium, LA left atrium, SVC superior vena cava, IVC inferior vena cava
The risks associated with PACs are well known. Although the incidence of thromboembolic complications is increased with PAC monitoring for longer periods of time, thrombi have been noted attached to PACs within 1–2 h after insertion. Our case suggests early thrombus formation (within minutes) on a newly inserted PAC. One should be aware of such potential
complications when considering PAC insertion, even for brief periods. Conflicts of interest On behalf of all authors, the corresponding author states that there is no conflict of interest. Informed consent patient.
Consent for publication was obtained from the
