Education And Debate

Lesson of the Week: Infected right atrial thrombus presenting as pulmonary embolism complicating central venous cannulation

BMJ 1995; 311 doi: (Published 11 November 1995) Cite this as: BMJ 1995;311:1288
  1. A Sajjad, registrara,
  2. P A Carey, registrar in cardiologyb,
  3. I R Arnold, consultant**a,
  4. S R Smith, consultanta
  1. aHorton General Hospital NHS Trust, Banbury, Oxon OX16 9AL
  2. bJohn Radcliffe Hospital, Headington, Oxford OX3 9DU
  1. Correspondence to: Dr Smith.
  • Accepted 12 June 1995

Although the vast majority of pulmonary emboli arise from the iliac and femoral veins, we present a case that illustrates that other potential sources should be considered, especially when recurrent pulmonary emboli occur despite adequate anticoagulation.

Case report

A 64 year old man presented with fever and left sided pleuritic chest pain two weeks after a laminectomy. A ventilation perfusion scan showed multiple areas of ventilation-perfusion mismatch and he was anticoagulated. Subsequently he remained well until readmission four months later with sudden onset of chest pain, dyspnoea, fever, and rigors. A pansystolic murmur was noted on examination. …

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