Central venous catheter fracture with fragment embolism

Clinical History

A 51-year-old asymptomatic man with colon carcinoma undergoing chemotherapy presented with malfunction of a central venous catheter (CVC), that had been properly positioned. There was no local swelling or any evidence of fluid leakage.

Imaging Findings

Thoracic CT (Figure 1 and 2) showed a fractured CVC in the right subclavian vein (tip is flagged with an arrow). The distal fragment was located in the descending branch of the left pulmonary artery. Chest radiograph after CVC removal (Figure 3) showed the migrated fragment (arrow).

Discussion

The placement of CVC can lead to early complications (such as incorrect position, improper anchoring of the reservoir, infection, vascular perforation, hemothorax, pneumothorax, hemorrhagic pericardial effusion) and late complications (for example drug leakage, mechanical malfunction, thrombosis, migration of the catheter, fragment embolism) (1, 2).
Migration of the tip of CVC is not an uncommon event and the mechanism is not clear - increased intrathoracic pressure, changing the body position or physical movements can be potential causes (1, 2).
The most common symptoms associated with catheter migration include chest wall
swelling at the injection port chamber and pain in the shoulder. Other suggestive
features include withdrawal occlusion, resistance to injection of fluid, sudden onset of
cough or chest pain and palpitations. However, migration to the pulmonary artery or its branches is frequently asymptomatic since there are few sensory endings in the vascular endothelium (1, 2).
Monitoring with chest radiography helps in early detection. CVC removal and replacement are usually required (1, 2). In this case, the proximal part of CVC was removed and it was decided not to remove the distal fragment after weighing the risks and benefits, opting for imaging follow-up.

Differential Diagnosis List

Final Diagnosis

Spontaneous central venous catheter fracture with fragment embolism

URL:	https://eurorad.org/case/11945
DOI:	10.1594/EURORAD/CASE.11945
ISSN:	1563-4086