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Type: Comentário
Title: Patient In Chronic Hemodialysis With Right Atrial Mass: Thrombus, Fungal Endocarditis Or Atrial Myxoma?
Title Alternative: Paciente Em Hemodiálise Crônica Com Massa Em átrio Direito: Trombo, Endocardite Fúngica, Ou Mixoma Atrial?
Author: Salani
Talita G.; Borges
Cynthia de Moura; Urbini
Carolina S.; Schincariol
Patrícia; Quadros
Kélcia Rosana da Silva; Ribeiro-Alves
Maria Almerinda; Oliveira
Rodrigo Bueno de
Abstract: We present the case report of a 19-year-old patient with chronic kidney disease due to chronic glomerulonephritis, in hemodialysis (HD) by central catheter, with the incidental finding of a mass of 28x16 mm in right atrium (RA). The diagnosis of thrombus, infective endocarditis or myxoma were considered. Given the context of immunosuppression and difficult access vascular therapeutic practice has proved complex. Although Doppler echocardiography suggested thrombus in RA, nuclear magnetic resonance imaging (MRI) indicated for the diagnosis of myxoma in RA. In both conditions, the proposed surgical approach was limited by intense immunosuppression history and the risk of infectious complications. Throughout the treatment, the general state of K.M.F. remained satisfactory and revealed no signs or symptoms related to atrial dysfunction. The absence of fever and negative blood cultures excluded infective endocarditis. Prior echocardiogram report without masses in the RA decreased the chance of cardiac myxoma. The therapeutic response to anticoagulation confirmed the diagnosis of thrombosis. After 180 days of anticoagulation, there was significant reduction in mass. The patient developed asymptomatic. The diagnosis of mass in RA can be a challenge and only the evolution of the case was able to guide the appropriate conduit. While MRI has high sensitivity and specificity for the diagnosis of cardiac myxoma, the interpretation of images can be subjective. Controversial point is the removal of the catheter in such cases, which is subject discussed throughout the report.
Subject: Catheters
Renal Dialysis
Diálise Renal
Editor: Sociedade Brasileira de Nefrologia
Citation: Jornal Brasileiro De Nefrologia. Sociedade Brasileira De Nefrologia, v. 38, n. 4, p. 462 - 465
Rights: aberto
Date Issue: 2016
Appears in Collections:Unicamp - Artigos e Outros Documentos

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