Korean Circ J.  2010 Sep;40(9):468-470. 10.4070/kcj.2010.40.9.468.

Long Journey of Sclerosant From the Esophagus to the Right Atrium

• Park JS
• Park JJ
• Lim SK
• Choi BJ
• Choi SY
• Yoon MH
• Hwang GS
• Tahk SJ
• Shin JH

• KMID: 1456141
• DOI: http://doi.org/10.4070/kcj.2010.40.9.468

Abstract

A 34-year-old man, who had been treated with an endoscopic injection of a mixture of n-butyl-2-cyanoacrylate (Histoacryl) and Lipiodol for control of variceal bleeding 6 months previously, presented with an intracardiac mass in the right atrium (RA). Two-dimensional echocardiography revealed an intracardiac mass in the RA that appeared to extend from the inferior vena cava. The origin of the sclerosant was traced by computed tomography (CT). This is a very rare case in which the sclerosant migration route was demonstrated by CT scan. The findings of this case suggest that the systemic migration of sclerosant into an intracardiac chamber should be considered in patients with an intracardiac mass, especially with a history of previous sclerotherapy for variceal bleeding.

Keyword

N-butyl-2-cyanoacrylate; Esophageal varix; Sclerotherapy; Embolism; Right atrium

MeSH Terms

Adult
Echocardiography
Embolism
Enbucrilate
Esophageal and Gastric Varices
Esophagus
Ethiodized Oil
Heart Atria
Hemorrhage
Humans
Sclerotherapy
Vena Cava, Inferior
Enbucrilate
Ethiodized Oil

Figure

• 

  Fig. 1 Transthoracic echocardiography shows an elongated intracardiac mass in the right atrium (arrow), which appears to extend from the inferior vena cava. A: parasternal short axis view, aortic valve level. B: off-axis modified four-chamber view.

• 

  Fig. 2 Portal-phase abdominal computed tomography scans with coronal reconstruction demonstrate a partial radio-opaque and radiolucent intraluminal material consistent with a mixture of sclerosant and thrombus, which originates from the gastroesophageal junction (1) and forms an intraluminal and intracardiac mass traversing a gastrorenal shunt (2), the left renal vein (3), the inferior vena cava (4) and right atrium (5).

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