Totally thoracoscopic beating-heart resection of a catheter-related right atrial thrombus: a case report

Figures

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  Figure 1. Preoperative multimodality imaging of the right atrial mass. (A–D) Transthoracic echocardiography (TTE, Nov.25, 2025) showing a 27 × 16 mm isoechoic mass in the right atrium, extending toward the tricuspid annulus and appearing to originate from the superior vena cava, with an additional 8 mm isoechoic segment within the SVC; left ventricular systolic function was normal (EF 63%). (E–H) Transesophageal echocardiography (TEE, Dec.03, 2025) showing an irregular isoechoic mass measuring 21 × 17 mm in the posteroinferior right atrium, with a slightly broad base, well-define margin, heterogeneous internal echogenicity, and scattered punctate hyperechoic foci; the mass exhibited slight mobility during the cardiac cycle and was located approximately 11 mm from the inferior vena cava orifice; a neoplastic lesion could not be excluded. (I,J) Cardiac computed tomography venography (CTV, Nov.27, 2025) showing a nodular filling defect in the right atrium (11 × 14 mm), with low-to-slightly-high attenuation on non-contrast images, favoring thrombus. (K,L) Cardiac magnetic resonance imaging (CMR, Dec.01, 2025) showing a round, low-signal filling defect in the right atrium (17 × 14 × 20 mm)…

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  Figure 2. Chest radiographs obtained during TIVAP use, showing sequential changes in catheter tip position: (A) immediately after TIVAP implantation, with the catheter tip at the superior border of T8; (B) during the third cycle of chemotherapy, with the tip at the T6–T7 level; (C) during the fifth cycle of chemotherapy, with the tip at the T8 level.

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  Figure 3. Intraoperative thoracoscopic view of the right atrial thrombus, showing a friable, round mass approximately 25 mm in diameter near the posterior tricuspid annulus, with an irregular surface, a broad base, and firm attachment to the right atrial wall adjacent to the tricuspid orifice.