Case Study: Right atrium thrombus in a female patient

Case Presentation

A 35-year-old female patient presented at the family physician’s clinic at midnight, with sudden onset dyspnoea for about the past hour. She had a history of hypertension since her pregnancy.

Examination

The patient was in distress with chest congestion and tachycardia, but no cyanosis.

Vitals:

  • BP.140/80 mmHg
  • P: 140/min
  • SpO2 by pulseoxy meter: 82

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Investigations

  • X-ray of chest: Bilateral Basal Congestion s/o congestion. Reported as consolidation
  • D Dimer: 2000
  • CBC: WBC count 3500, platlet 75000, rest of the reports normal
  • 2 D Echo: tumor in right atrium, probably of myxoma
  • Cardiac MRI: Large right atrial thrombus
  • Cardiac Angio: Normal

Treatment

Considering the age and the season of bronchitis, acute bronchitis with spasm was first suspected and treated with standard nebulization, but there was no response. The patient was then referred to the hospital for further care. Upon admission, an ECG showed tachycardia with St T changes. The patient was put on Bi-Pep to maintain O2 to 100%. She was again nebulized, but with no satisfactory response. IV diuretics were given, and the patient responded.

Final Treatment

Patient was referred to a CT surgeon, and the thrombus was removed.

Learning Points/Take Home Messages

Need to keep eyes and thoughts open when a patient presents with typical day-to-day complaints but does not respond well to the conventional treatment.

About The Author

Dr. Vachharajani is an experienced practicing family physician in Ahmedabad, Gujarat, with a special interest in obesity and lifestyle-related disorders. With a genuine passion and enthusiasm for healthcare information technology (HIT), he has championed the cause of using HIT in day-to-day clinical practice. In addition to his, MBBS, he holds a post-graduate certificate in environmental and occupational health (PGDMCH).

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