In children, right atrial thrombosis is associated with placement of a central venous catheter.
Berman W Jr, Fripp RR, Yabek SM, Wernly J, Corlew S. Great vein and right atrial thrombosis in critically ill infants and children with central venous lines. Chest. 1991 Apr;99(4):963-7. PubMed PMID: 2009803.
Rizzi M, Albisetti M. Treatment of arterial thrombosis in children: Methods and mechanisms. Thromb Res. 2018 Sep;169:113-119. doi: 10.1016/j.thromres.2018.07.013. Epub 2018 Jul 6. Review. PubMed PMID: 30032038.
Children who require a central venous catheter are usually very ill and often are in the neonatal intensive care unit or a pediatric intensive care unit. However, indwelling central venous catheters are also placed in children/adolescents with cancer to administer chemotherapy, in children/adolescents with cystic fibrosis so that antibiotics can be administered readily, and in children/adolescents with a variety of conditions to administer parenteral nutrition.
CRITICALLY ILL NEONATES
One case-control study that was done in critically ill neonates who required a central venous catheter and assessed the risk factors for intracardiac thrombosis in the right atrium (RA) and superior vena cava (SVC) was identified. The study found that the surgical cut-down technique, a maternal history of gestational diabetes, staphylococcal infection, and central venous catheter placement in the superior vena cava were factors that increased the risk of an intracardiac thrombosis in the RA and superior vena cava. Some factors increased the risk substantially—by a factor of 10 (maternal gestational diabetes) and 7 (staphylococcus infection).
Ulloa-Ricardez A, Romero-Espinoza L, Estrada-Loza Mde J, et al. Risk Factors for Intracardiac Thrombosis in the Right Atrium and Superior Vena Cava in Critically Ill Neonates who Required the Installation of a Central Venous Catheter. Pediatr Neonatol. 2016 Aug;57(4):288-94. doi:10.1016/j.pedneo.2015.10.001. Epub 2015 Nov 5. PubMed PMID: 26747618.
The independent risk factors for intracardiac thrombosis in the RA and
SVC were the surgical cut-down insertion technique (OR = 2.98; 95% CI:
1.18-9.10), a maternal history of gestational diabetes/diabetes mellitus (OR = 10.64; 95% CI: 1.13-121.41), Staphylococcus epidermidis
infection (OR = 7.09; 95% CI: 1.09-45.92), and CVC placement in the
SVC (OR = 5.77; 95% CI: 1.10-30.18).
OTHER CONDITIONS IN CHILDREN
One case report of thrombosis of the right atrium (Case 1) in an adolescent patient with cystic fibrosis and an indwelling central venous catheter was identified. The authors suggest the possibility that cystic fibrosis might be associated with hypercoagulability and review the evidence for this.
Kandamany N, Elnazir B, Greally P. Increased vigilance needed for the detection of thrombotic complications of central venous access in adolescent cystic fibrosis patients. Front Pediatr. 2014 Nov 19;2:117. doi: 10.3389/fped.2014.00117. eCollection 2014. Review. PubMed PMID: 25478551; PubMed Central PMCID: PMC4237125.
Several reports of thrombus in the right atrium in children with a central venous catheter being given parenteral nutrition were identified. Pennington suggested that high concentration dextrose solutions might contribute to thrombosis risk in people receiving parenteral nutrition via a central venous catheter.
Pennington CR. Right atrial thrombus: a complication of total parenteral nutrition. Br Med J (Clin Res Ed). 1987 Aug 15;295(6595):446-7. PubMed PMID: 3115494; PubMed Central PMCID: PMC1247309.
Pliam MB, McGough EC, Nixon GW, Ruttenberg HD. Right atrial ball-valve thrombus: a complication of central venous alimentation in an infant. Diagnosis and successful surgical management of a case. J Thorac Cardiovasc Surg. 1979 Oct;78(4):579-82. PubMed PMID: 113629.
Tarantino MD, Vasu MA, Von Drak TH, et al. Calcified thrombus in the right atrium: a rare complication of long-term parenteral nutrition in a child. J Pediatr Surg. 1991 Jan;26(1):91-3. PubMed PMID: 1900889.
A retrospective analysis of data of the risk of thrombosis (not limited to right atrial thrombosis) in children with a central venous catheter suggested that children with acute lymphoblastic leukemia were at particularly high risk. The full text of this publication could not be retrieved and the basis for this conclusion is unclear.
Chen K, Agarwal A, Tassone MC, et al. Risk factors for central venous catheter-related thrombosis in children: a retrospective analysis. Blood Coagul Fibrinolysis. 2016 Jun;27(4):384-8. doi: 10.1097/MBC.0000000000000557. PubMed PMID: 26977751.
“Acute lymphoblastic leukaemia was a major clinical risk factor for