MedPix® Patient Chart - Case No: 3916 :: - Review Images

History of ALL refractory to multiple chemotherapy regimens.
Patient complains that for the last several months, he has experienced increasing pain in his left shoulder with his chemotherapy infusions through his left-sided subcutaneous chest port which was placed at an outside institution. The pain is self-resolved several minutes after the infusion is completed.

Visibly enlarged supraclavicular lymphadenopathy.
Left-sided subcutaneous chest port.

- Review Images for PT: 3916

Scout image of his chest port and catheter demonstrate normal appearing port and catheter with venous access of the left axillary vein.

Fluoroscopic images following contrast injection through the port demonstrate extravasation of the contrast material into the soft tissues of the left chest and shoulder.

- Review Images for PT: 3916

Catheter fracture with leakage

- Review Images for PT: 3916

Dx: Catheter fracture with leakage

Dx Confirmed by:

- Read

Replacement of subcutaneous central venous access device.

Complications associated with indwelling central venous access devices are relatively common (see factoid). This particular complication is not common, however. The extravasation of contrast material and the patient's complaints are virtually diagnostic of a catheter fracture with leakage of infusion material at the location indicated by the arrows on the images. This complication is more common in cases where the subclavian vein is accessed due to the catheters course trough the soft tissues before entering the lumen of the vein. In particular, passage through the subclavian musculature can create a relatively fixed region of catheter that will eventually weaken with repetitive arm motion.

Indwelling venous access devices such as tunneled catheters, dialysis catheters, peripherally inserted central catheters (PICC lines), and subcutaneous venous access devices (ports) have been available for more than 20 years. They have drastically improved comfort and convenience associated with the administration of chemotherapy and other intravenous therapies.

Tunnelled central catheters and implantable ports are commonly placed if long-term (more than a few months) IV therapy is required. Examples of tunnelled catheters are Groshong, Broviac, and Hickman catheters. Subcutaneous venous access devices (ports) are commonly located in the arm or chest.

Complications with these devices is relatively common with some studies reporting as high as a 78% complication rate. More commonly a complication rate of between 22% and 54% is experienced.

Complications associated with the initial placement and long term use of these devices include:
   Pneumothorax/hemothorax
   Brachial nerve injury
   Air embolus
   Cardiac arrythmias
   Tunnel or port infection/sepsis
   Venous thrombosis
   Loss of catheter function (fibrin sheath/ball-valve effect)
   Device/catheter migration (port flipping)
   Damaged/leaking catheters (extravasation)
   Superior Vena Cava erosion