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Logo of bmjcrInstructions for authorsCurrent ToCBMJ Case Reports
BMJ Case Rep. 2010; 2010: bcr0920081019.
Published online Oct 21, 2010. doi:  10.1136/bcr.09.2008.1019
PMCID: PMC3038023
Rare disease
An embolus in the right atrium caught in the Chiari network and resistant to thrombolysis
Motovska Zuzana,1 Widimsky Petr,1 Bilkova Dana,1 Penicka Martin,1 Linkova Hana,1 Kautznerova Dana,2 Kolesar Miroslav,3 Koldová Ludmila,3 and Kvasnicka Jan4
1Third Medical Faculty of Charles University, Prague, Czech Republic
2Institute of Clinical and Experimental Medicine, Prague, Czech Republic
3Cardiocentre University Hospital Vinohrady, Prague, Czech Republic
4Thrombosis Center of General University Hospital, Prague, Czech Republic
Correspondence to Motovska Zuzana, zuzana.motovska/at/
This case report describes a patient with thromboemboli trapped in the Chiari network within the right side of the heart and resistant to thrombolysis. The right atrial masses were completely removed under cardiopulmonary bypass. Histological evaluation confirmed a mixed thromboemboli, with thrombus structures showing signs of organisation and surrounded by a fibrous capsule. The plasma level of the plasminogen activator inhibitor type-1 (PAI-1) was 50% higher than the normal upper limit. In this presented case, the Chiari network displayed a protective function but the expansion and organisation of the thromboembolus found there made it resistant to lytic treatment. Another important factor that could have influenced the resistance to thrombolysis was the high level of PAI-1.
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