Multiple Polypoid Thrombi of Right Atrium: Report of a Case

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Abstract
An unusual cardiac lesion consisting of multiple large and small polypoid thrombi was found at autopsy in the right atrium of a 59 year old man who had massive pulmonary embolization 3 years before death arising from thrombophelebitis of the leg, treated by inferior vena cava ligation. At death was found complete thrombo-embolic occlusion of the left pulmonary artery without lung infarction. The pulmonary vascular bed was diffusely fibrotic suggesting the possibility of chronic embolization from the right atrium. A syndrome of respiratory failure from pulmonary hypertension and heart failure with cor pulmonale was produced. There were no myocardial lesions other than the hypertrophy of the right ventricle. An unexplained feature of the case was a chronic leukemoid reaction thought to be secondary to organization of repeated pulmonary microinfarcts. The polypoid thrombi nearly filled the right atrium and showed narrow fibrous stalks with collagenization but the basal portions and an expansion of degenerated fibrinous material distally. Such polypoid thrombi have not been reported in the English literature but mention of similar lesions have been found in older German writings. Disease caused by thrombo-emboli located in the right atrium is emphasized. Angiocardiography is suggested for diagnosis.