# Hemodialysis Catheter-Associated Right Atrial Thrombus Diagnosed via Point of Care Transesophageal Echocardiogram

## TL;DR

A case study shows how point-of-care transesophageal echocardiography can detect a rare heart clot linked to dialysis catheters, which is often missed by standard tests.

## Contribution

Demonstrates the diagnostic value of TEE over TTE for detecting HDCRAT in critical care settings.

## Key findings

- TEE successfully identified a right atrial thrombus that TTE missed in a patient with a hemodialysis catheter.
- The patient was treated with anticoagulation, local thrombolysis, and delayed catheter removal.
- TEE is suggested as a superior diagnostic tool for HDCRAT in intensive care units.

## Abstract

Catheter-associated right atrial thrombus (CRAT) is a potential complication of central venous catheter placement and is associated with an increase in morbidity and mortality. The precise incidence of CRAT is unknown, and there is a lack of clear screening and management guidelines for this condition. Additionally, the diagnosis is often missed when using transthoracic echocardiography (TTE) alone. Here, we present a case of a 64-year-old female admitted to the medical intensive care unit with multiorgan dysfunction who was diagnosed with hemodialysis catheter-associated right atrial thrombus (HDCRAT) via intensivist-performed point of care transesophageal echocardiography (TEE) after an initial TTE was negative. This patient was successfully treated with systemic anticoagulation, local thrombolysis, and delayed removal of the temporary hemodialysis catheter. Our experience serves to highlight the improved visualization of the right atrium and the diagnostic superiority of HDCRAT with TEE. We suspect that with greater utilization of TEE among intensivists, CRAT and HDCRAT will have increased recognition. It is imperative that intensivists are aware of this complication and various management strategies. Still, more studies are needed to establish clear management guidelines for CRAT and the associated complications.