IS case 497: Broken central catheter with embolization of distal fragment

Matthew Thrall, MD

University of Rochester

Imaging Sciences URMC 2010
Publication Date: 2010-08-30

History

Patient is a 64-year-old male seen for left peripherally inserted central catheter (PICC) placement secondary to a malfunctioning right-sided catheter.

Findings

Chest x-ray revealed right-sided catheter with its tip severed and the long distal end appearing in the right pulmonary artery. The left-sided PICC was also malpositioned with tip in the left internal jugular vein.

Diagnosis

Broken central catheter with embolization of distal fragment

Discussion

One of the occasional complications of catheters is fracturing of the catheter with embolization of the distal fragment into a downstream vessel. Often these catheters will stop functioning properly, which is a tip off to look for a fracture. Prolonged use is a risk factor for this event, as catheters can wear down over time. The distal fragment can embed in the vena cava, right atrium, right ventricle, or pulmonary arteries.

After the fracture is identified, a decision must be made individually as to whether to retrieve the fragment (usually via interventional radiology). Serious complications from leaving the fragment in place can occur, such as thrombus formation with pulmonary infarction, pulmonary embolism, infection, or perforation. However, there are also risks with retrieval of the segment, including thrombus or vessel rupture, as these catheters can adhere to the wall of the vessel over time. There is a lack of large studies to accurately assess the risk of removal versus leaving the catheter in place

References

  1. Hunter TB, Taljanovic MS, Tsau PH, Berger WG, Standen JR. Medical devices of the chest. Radiographics. 2004 Nov-Dec;24(6):1725-46. PMID: 15537981
  2. Jones SA, Giacomantonio M. A complication associated with central line removal in the pediatric population: retained fixed catheter fragments. J Pediatr Surg. 2003 Apr;38(4):594-6. PMID: 12677573
  3. Wolf F, Schernthaner RE, Dirisamer A, et al. Endovascular management of lost or misplaced intravascular objects: experiences of 12 years. Cardiovasc Intervent Radiol. 2008 May-Jun;31(3):563-8. PMID: 17955287

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