Atrial Thrombus in a Neonate: A Diagnostic Challenge

Abstract

Introduction Left atrial thrombus is a rare finding in a neonate. In the previous literature, atrial thrombi have been associated with catheter placement or congenital heart disease in a preterm infant.

Case We report the case of a full-term neonate with no known risk factors found to have a left atrial thrombus. The neonate was born at 38 weeks' gestation to a 31-year-old female via cesarean section who was sent to the normal nursery. On postnatal day 5, the infant was noted to have low-to-medium level of oxygen saturations (∼90%) and was transferred to the neonatal intensive care unit with an echocardiogram completed on postnatal day 6 demonstrating a mobile, pedunculated mass attached to the left atrial septum with an appearance concerning for atrial myxoma. The infant underwent surgical resection on postnatal day 8 and pathology revealed the mass to be a left atrial thrombus.

Discussion The rare finding of an atrial thrombus in a neonate has previously been associated with central venous catheter placement or congenital heart disease. This case is unusual in that the patient had neither condition. Although echocardiogram findings appeared more consistent with atrial myxoma, final pathology revealed a left atrial thrombus. Additionally, hypercoagulability work-up for this neonate was largely negative. This report underscores the importance of identification, search for etiology, and prompt therapy to prevent potential catastrophic outcomes.

Keywords

atrial thrombus - neonate - infant - thrombus resection - heparin

• References

• 1 Kenny D, Tsai-Goodman B. Neonatal arterial thrombus mimicking congenital heart disease. Arch Dis Child Fetal Neonatal Ed 2007; 92 (1) F59-F61
• 2 Ina S, Futatani T, Higashiyama H , et al. Left atrium thrombus in an extremely low-birthweight infant with late-onset circulatory dysfunction. Pediatr Int 2012; 54 (4) 555-558
• 3 Ferrari F, Vagnarelli F, Gargano G , et al. Early intracardiac thrombosis in preterm infants and thrombolysis with recombinant tissue type plasminogen activator. Arch Dis Child Fetal Neonatal Ed 2001; 85 (1) F66-F69
• 4 Aspesberro F, Beghetti M, Oberhänsli I, Ozsahin H, Humbert J, Rimensberger PC. Local low-dose urokinase treatment of acquired intracardiac thrombi in preterm infants. Eur J Pediatr 1999; 158 (9) 698-701
• 5 Al Dhahri KN, Sandor GG, Duncan WJ. Intra-atrial thrombus in a neonate with coarctation of the aorta. Cardiol Young 2006; 16 (4) 392-394
• 6 Romano A, Weinberg PM, Woolf PK, Vetter VL. Pulmonary venous obstruction from left atrial thrombus in hypoplastic left heart syndrome. Pediatr Cardiol 1989; 10 (2) 105-107
• 7 Beppu S, Nimura Y, Sakakibara H, Nagata S, Park YD, Izumi S. Smoke-like echo in the left atrial cavity in mitral valve disease: its features and significance. J Am Coll Cardiol 1985; 6 (4) 744-749
• 8 World Health Organization Classification of Tumours. Pathology and genetics of tumours of the lung, pleura, thymus and heart. In: William D. Travis, Elizabeth Brambilla, H. Konrad, Muller-Hermelink, and Curtis C. Harris eds. WHO Publications Center. Lyon: IARC Press; 2004: 260-263
• 9 Scheffel H, Baumueller S, Stolzmann P , et al. Atrial myxomas and thrombi: comparison of imaging features on CT. AJR Am J Roentgenol 2009; 192 (3) 639-645
• 10 Kenet G, Maayan-Metzger A, Rosenberg N , et al. Thrombophilia does not increase risk for neonatal complications in preterm infants. Thromb Haemost 2003; 90 (5) 823-828