A rare cause of right atrial mass: Thrombus formation and infection complicating a ventriculoatrial shunt for hydrocephalus

BACKGROUND Thrombus formation around the intracardiac end of the catheter, thromboembolism, and infection are the most important and life-threatening complications of ventriculoatrial shunts. In this article we report a patie nt with a large right atrial mass that was diagnosed by 2-D echocardiogram and removed via standard median sternotomy and cardiopulmonary bypass. CASE DESCRIPTION A 63-year-old man who had a right ventriculoatrial shunt w as admitted to our department in a septic clinical condition. His hemoglobi n was 10.7 grams, white blood cell count was 22,900/mm(3), and sedimentatio n rate was 50 mm/hr. Blood cultures grew coagulase negative staphylococcus. The echocardiogram showed a right atrial mass at the tip of the shunt cath eter. The mass had a cystic and "glove-like" appearance and had a pendulous motion in the right atrium. After combined antibiotic therapy for 10 days, symptoms were relieved but echocardiographic findings did not change, A su rgical approach was chosen because of the unchanged size of the mass and th e risk of pulmonary embolism. First, the distal part of the ventriculoatria l shunt was separated from its pump and a new ventriculoperitoneal shunt wa s placed. After this, a standard median sternotomy, cardiopulmonary bypass and right atriotomy was performed. The tip of the shunt catheter with the a ttached pedunculated mass was removed. CONCLUSION There are few cases of a large right atrial thrombus secondary t o a ventriculoatrial shunt in the literature. Because of these serious comp lications of ventriculoatrial shunting, careful 2-D transthoracic echocardi ographic examination should be mandatory for patients with ventriculoatrial shunts. (C) 1999 by Elsevier Science Inc.