• Fares Abboud, Ranim Nakhal, Afif Alshwaiki, Majd Hanna, and Khachig Ishkhan.
• Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic.
• Medicine (Baltimore). 2024 Aug 23; 103 (34): e39443e39443.

RationaleAlcoholic cardiomyopathy (ACM) is associated with various cardiac complications, but the development of isolated right atrial (RA) thrombus without deep vein thrombosis is rare and presents diagnostic challenges.Patient ConcernsA 53-year-old Hispanic male presented with shortness of breath, chills, cough, bilateral lower extremity edema, and distended abdomen.DiagnosesThe patient was diagnosed with ACM, liver cirrhosis, and a large RA thrombus. Initial transthoracic echocardiography showed severe left ventricular systolic dysfunction but failed to detect the RA mass. Subsequent computed tomography scan and transesophageal echocardiography revealed a large oval mass in the RA, measuring 40 mm × 22 mm × 18 mm.InterventionsThe patient received guideline-directed medical therapy for heart failure and anticoagulation with enoxaparin. He underwent cardiac catheterization for mechanical thrombectomy, which was minimally successful.OutcomesThe patient's condition was managed with the prescribed interventions. Regular follow-up was planned to assess thrombolysis.LessonsRA thrombosis is an uncommon complication of ACM. A multimodal imaging approach, with a low threshold for transesophageal echocardiography, is crucial in evaluating patients with ACM who present with cardiac complications. This approach enables accurate diagnosis and management of rare conditions like isolated RA thrombosis.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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