Fibrinolytic therapy for superior vena cava and right atrial thrombosis: Diagnosis and follow-up with biplane transesophageal echocardiography

Thrombosis of the superior vena cava and other central venous trunks is a complication that is associated with the implantation of pacemakers and central venous catheters that are used for chemotherapy or total parenteral nutrition. This complication occurs somewhat more frequently than expected because many of these thrombi are clinically unnoticed and are finally diagnosed at autopsy. Phlebographic studies have shown that thrombosis is related to central venous catheters in up to 52 “;# of patients who have not received anticoagulation therapy.l This complication may be treated satisfactorily with fibrinolytic agents such as streptokinase (SK), urokinase (UK), and tissue plasminogen activator. We report a patient with ischemic heart disease who had a catheter-related superior vena cava thrombosis with protrusion of the thrombus t,owards the right atrium, successfully treated with SK. Diagnosis and follow-up examinations were carried out by transthoracic and biplane transesophageal echocardiography. The patient was a 59-year-old man who had antecedents