J Cardiovasc Ultrasound.  2012 Dec;20(4):205-208. 10.4250/jcu.2012.20.4.205.

A Case of Carbon Monoxide Poisoning with Thrombus in Right Atrium

  • 1Cardiac Imaging Center, Asan Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. daehee74@amc.seoul.kr


Carbon monoxide is a nonirritant, odorless, colorless gas. Its effects are prominent in organs most sensitive to oxygen deprivation, such as the heart, brain, and kidney. Although less frequently, an association between thromboembolic events and carbon monoxide poisoning has been shown in the literatures. In this case, we report a case of atrial thrombus associated with carbon monoxide poisoning.


Carbon monoxide; Intoxication; Thrombus

MeSH Terms

Carbon Monoxide
Carbon Monoxide Poisoning
Heart Atria
Carbon Monoxide


  • Fig. 1 Transesophageal echocardiography showed a mass (arrow) attached to right atrial appendage with to (A) and fro (B) motion through tricuspid valve.

  • Fig. 2 Delayed enhancement images (DE-MRI) showed an 8 mm sized thrombus (arrow) in the right atrium.

  • Fig. 3 Echocardiographic follow-up at sixth day of anticoagulation (B) showed disappearance of mass originally attached to right atrial wall (A, arrow).


1. Van Meter KW. Tintinalli JE, Kelen GD, Stapczynski JS, editors. American College of Emergency Physicians. Carbon monoxide poisoning. Emergency medicine: a comprehensive study guide. 2000. 5th ed. New York: McGraw-Hill;1303.
2. Satran D, Henry CR, Adkinson C, Nicholson CI, Bracha Y, Henry TD. Cardiovascular manifestations of moderate to severe carbon monoxide poisoning. J Am Coll Cardiol. 2005. 45:1513–1516.
3. Ernst A, Zibrak JD. Carbon monoxide poisoning. N Engl J Med. 1998. 339:1603–1608.
4. Weaver LK. Carbon monoxide poisoning. Crit Care Clin. 1999. 15:297–317. viii
5. Marius-Nunez AL. Myocardial infarction with normal coronary arteries after acute exposure to carbon monoxide. Chest. 1990. 97:491–494.
6. Middleton GD, Ashby DW, Clark F. Delayed and longlasting electrocardiographic changes in carbon-monoxide poisoning. Lancet. 1961. 1:12–14.
7. Jang WI, Park JH. Transient left ventricular systolic dysfunction associated with carbon monoxide toxicity. J Cardiovasc Ultrasound. 2010. 18:12–15.
8. Enzer N, Spilberg S. Gangrene of lower extremity following carbon monoxide asphyxia. Am J Clin Pathol. 1946. 16:111–116.
9. Fowler PB. Gangrene of the leg following carbon-monoxide asphyxia. Lancet. 1954. 266:240–241.
10. Nagy Z, Kenéz J, Simon L, Mórocz K. [Partial thrombosis of the superior sagittal sinus following carbon monoxide poisoning]. Orv Hetil. 1984. 125:3181–3184.
11. Cambria S. [Thrombosis of the vein of Labbé with haemorrhagic cerebral infarction (author's transl)]. Rev Neurol (Paris). 1980. 136:321–326.
12. Condi M, Devaux C, Sallerin T. [A case of thrombosis of the mesenteric artery after carbon monoxide poisoning]. Anesth Analg (Paris). 1973. 30:353–358.
13. Breton J, Caroff J, Martin R, Dehouve A, Dehouve P. [Fatal obstruction of the basilar trunk following benign carbon monoxide poisoning]. Med Leg Dommage Corpor. 1969. 2:409–411.
14. Heidrich H, Klems H. [Bilateral thrombosis of the popliteal vein with diffuse muscular necrosis following CO intoxication]. Dtsch Med Wochenschr. 1969. 94:1367–1370. passim.
15. Lee SJ, Kang JH, Kim NY, Baek IW, Park MY, Shim BJ, Koh YS, Shin WS, Lee JM, Jeon HK. A case report of carbon monoxide poisoning induced cardiomyopathy complicated with left ventricular thrombus. J Cardiovasc Ultrasound. 2011. 19:83–86.
16. Davis MR, Fitzpatrick CM, Dixon PM, Kashyap VS. Thrombus-induced endothelial dysfunction: hemoglobin and fibrin decrease nitric oxide bioactivity without altering eNOS. J Surg Res. 2004. 122:121–129.
17. Felner JM, Churchwell AL, Murphy DA. Right atrial thromboemboli: clinical, echocardiographic and pathophysiologic manifestations. J Am Coll Cardiol. 1984. 4:1041–1051.
18. de Gregorio C, Grimaldi P, Lentini C. Left ventricular thrombus formation and cardioembolic complications in patients with Takotsubo-like syndrome: a systematic review. Int J Cardiol. 2008. 131:18–24.
19. Haghi D, Papavassiliu T, Heggemann F, Kaden JJ, Borggrefe M, Suselbeck T. Incidence and clinical significance of left ventricular thrombus in tako-tsubo cardiomyopathy assessed with echocardiography. QJM. 2008. 101:381–386.
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