• Images in cardiology

A 33 year old woman with thalassaemia major was referred to us for assessment of her myocardial iron status by cardiovascular magnetic resonance. Assessment of myocardial iron loading in the heart by the use of T2* measurements is the first non-invasive method that has been successfully validated for this purpose. Requiring regular blood transfusions for which a portacath had been inserted in 1992, she had never been formally anticoagulated. In cases of severe cardiac iron loading portacath insertion is often required to provide intravenous chelation treatment, and can also be used to provide long term intravenous access for the multiple blood transfusions. While being assessed a large mobile structure which appeared to be attached to the tip of the portacath was seen in the right atrium (highlighted by arrow.) The signal characteristics of the mass on various magnetic resonance imaging techniques indicates that this was a thrombus. Thrombus formation, which can then go on to embolise, is a recognised long term complication of a portacath, along with sepsis and leakage. The patient was subsequently treated with warfarin as she did not wish to have the line removed surgically.