Tuberc Respir Dis.  2007 Nov;63(5):449-453. 10.4046/trd.2007.63.5.449.

Two Cases of Fractured and Embolized Implanted Central Venous Chemoports in Lung Cancer

• Ju JY
• Cho JY
• Lim JH
• Cho GJ
• Chae DR
• Oh IJ
• Kim KS
• Kim YI
• Lim SC
• Kim YC
• Song SY
• Na KJ
• Kim YH
• Kim JK

• KMID: 2050480
• DOI: http://doi.org/10.4046/trd.2007.63.5.449

Abstract

Totally implanted central venous access devices for chemotherapy (chemoport) are being used increasingly in lung cancer patients. Vascular catheters are associated with various complications including infection, thrombosis as well as spontaneous fractures and embolization of the catheter, which is known as 'pinch-off syndrome'. 'Pinch-off syndrome' refers to the compression of a subclavian central venous catheter between the clavicle and first rib resulting in an intermittent or permanent obstruction, which can lead to tears, transection, or embolization. We report two cases of fractured and embolized implanted subclavian venous catheters in which the fragments were removed percutaneously. A 62-year-old man presented with back pain with a duration of a few weeks. The chest radiograph revealed complete transsection and embolization of the catheter into the right atrium. In addition, a 47-year-old woman with a chemoport had a grade 3 pinch-off sign in a chest radiograph demonstrating complete transsection and embolization of the catheter into the pulmonary artery. Both cases were managed by retrieving the embolized distal fragment percutaneously and removing the proximal section of the catheter.

Keyword

Chemoport; Pinch-off syndrome; Pinch-off sign

MeSH Terms

Back Pain
Catheters
Central Venous Catheters
Clavicle
Drug Therapy
Female
Fractures, Spontaneous
Heart Atria
Humans
Lung Neoplasms*
Lung*
Middle Aged
Pulmonary Artery
Radiography, Thoracic
Ribs
Thrombosis
Vascular Access Devices

Figure

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  Figure 1 A chest PA illustrates the fractured catheter tip located between the right first rib and the mid-clavicle. The distal fragment is seen in the right atrium.

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  Figure 2 Inferior Vena Cavography shows a distal fractured fragment in the right atrial area (left). The right femoral vein was punctured and the fractured catheter was removed using a snare wire (right upper and lower).

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  Figure 3 In a cross section, the configuration of the embolized portion of the catheter is not circular, but instead elliptical.

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  Figure 4 A chest PA and lateral films show the fractured chemoport catheter tip located between the left first rib and the mid-portion of the clavicle, and the distal fragment located in the main pulmonary artery.

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  Figure 5 Removal of the distal fragment of the fractured catheter percutaneously. After the right femoral vein was punctured, the tip of the fractured chemoport was captured using a snare with a guiding catheter, and removed through the right femoral venous sheath.

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