Spontaneous Fracture and Migration of a Catheter to the Pulmonary Artery

April 1, 2006

A 50-year-old woman with breast cancer presented for follow-up 2 months after undergoing a left mastectomy and chemotherapy through a port catheter implanted in the right subclavian vein. Because venous access had been difficult to achieve, the catheter was left in situ after treatment.

 

A 50-year-old woman with breast cancer presented for follow-up 2 months after undergoing a left mastectomy and chemotherapy through a port catheter implanted in the right subclavian vein. Because venous access had been difficult to achieve, the catheter was left in situ after treatment.

When examining the patient's chest film, Fadi I. Jabr, MD, of Florence, Ore, noted that the proximal part of the port catheter was in the normal location, but the tip of the catheter (about an 8-cm segment) had embolized into the descending branch of the left pulmonary artery. No metastasis was noted.

The patient was asymptomatic. She denied dyspnea and cough and had no history of chest trauma.

The port catheter system, also called Port-a-Cath, is usually a safe, convenient, and reliable method for venous access in patients with cancer who require prolonged chemotherapy. However, occlusion, infection, hematoma, and leakage can occur.1 Other rare complications include migration, malfunction, fracture, or disconnection of the catheter and pneumothorax.2

Spontaneous fracture and migration of a port catheter to the pulmonary artery have been reported.3 The mechanism of fracture may be related to long-standing compression of the catheter within the narrow space between the rib and clavicle.3 Typically, the catheter may wear off on the medial side because of a scissoring effect associated with free shoulder joint movement. This exerts additional forces on this wearing point and leads to catheter fracture or nip, which appears on a radiograph as a "pinch-off sign." Cannulation of the internal jugular vein instead of the median subclavian vein is one way to avoid a potential fracture.4

Removal of an implanted catheter after completion of chemotherapy is recommended. Patients with implanted catheters require close monitoring even in the absence of symptoms. Obtain posteroanterior and lateral chest x-ray films routinely 3 weeks after catheter implantation.

The catheter fragment in this patient was removed successfully with a transvenous snare under fluoroscopic guidance.

References:

REFERENCES:


1.

Strum S, McDermed J, Korn A, Joseph C. Improved methods for venous access: the Port-A-Cath, a totally implanted catheter system.

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1986;4: 596-603.

2.

Kock HJ, Pietsch M, Krause U, et al. Implantable vascular access systems: experience in 1500 patients with totally implanted central venous port systems.

World J Surg.

1998;22:12-16.

3.

Noyen J, Hoorntje J, de Langen Z, et al. Spontaneous fracture of the catheter of a totally implantable venous access port: case report of a rare complication.

J Clin Oncol.

1987;5:1295-1299.

4.

Hou WY, Sun WZ, Chen YA, et al. "Pinch-off sign" and spontaneous fracture of an implanted central venous catheter: report of a case [in Chinese].

J Formos Med Assoc.

1994;93(suppl 1):S65-S69.