Point-of-Care Ultrasound Detection of a Right Atrial Thrombus Leading to AngioVac Thrombectomy in a Patient With Sickle Cell Crisis

Point-of-care ultrasound (POCUS) has emerged as a valuable extension of the bedside physical examination, enabling rapid identification of cardiac abnormalities that may not be clinically apparent. Intracardiac masses, particularly in the right atrium, represent a diagnostic challenge and carry significant clinical implications, including the risk of embolization. Early recognition is critical to guide timely management. We report the case of a patient admitted with vaso-occlusive sickle cell crisis who underwent bedside cardiac ultrasound as part of the clinical evaluation. POCUS revealed a previously undocumented, mobile right atrial mass measuring approximately 3.1×2.2 cm near the junction of the inferior vena cava and right atrium, not associated with the tricuspid valve and without prolapse into the right ventricle. A prior transthoracic echocardiogram done six months ago had not reported this finding. Subsequent formal echocardiographic evaluation confirmed the presence of a right atrial mass concerning for thrombus. Given the size, mobility, and potential embolic risk, the patient underwent mechanical thrombectomy using the AngioVac system, with successful removal of a significant thrombotic burden. Right atrial thrombi are uncommon but clinically significant due to their association with thromboembolic events. This case highlights the role of POCUS in the early detection of intracardiac pathology and its impact on clinical decision-making. Prompt identification at the bedside facilitated expedited diagnostic confirmation and definitive intervention. POCUS can serve as a critical diagnostic tool in identifying unexpected intracardiac abnormalities, enabling early intervention in high-risk conditions. Its integration into routine hospital medicine practice may facilitate early detection of high-risk intracardiac thrombi and enable timely intervention.