Case Of the Week (COW) 17 March 2013
Answer:
Migrated catheter of chemoport.
Findings and discussion:
There is right paratracheal stripe thickening due to lymph nodes and lesions in right 4th rib and right scapula suggesting lymphomatous infiltration of the bones. But the important finding in this case is with regard to the central venous catheter. Note the catheter with its proximal end in left brachiocephalic vein. A normal subclavian central venous catheter or chemoport will have its proximal end extending outside. The normal distal position for any central venous access catheter is the superior vena cava, just above the SVC-Right atrial junction. This is approximately the level of the junction of the SVC shadow and the right main bronchus. If it extends below, it can reach the right atrium, predisposing to arrhythmias and if further down, will go into the inferior vena cava. The distal tip of the catheter in this case goes below the cardiac shadow and deflects to the left, possibly into the left hepatic vein which lies in this region. The migrated catheter was extracted using a snare by transjugular route.
Contributed By:
Dr. Iyappan Ponnuswamy MD, FRCR
Consultant Radiologist, Kauvery Hospital, Chennai
Answer:
Migrated catheter of chemoport.
Findings and discussion:
There is right paratracheal stripe thickening due to lymph nodes and lesions in right 4th rib and right scapula suggesting lymphomatous infiltration of the bones. But the important finding in this case is with regard to the central venous catheter. Note the catheter with its proximal end in left brachiocephalic vein. A normal subclavian central venous catheter or chemoport will have its proximal end extending outside. The normal distal position for any central venous access catheter is the superior vena cava, just above the SVC-Right atrial junction. This is approximately the level of the junction of the SVC shadow and the right main bronchus. If it extends below, it can reach the right atrium, predisposing to arrhythmias and if further down, will go into the inferior vena cava. The distal tip of the catheter in this case goes below the cardiac shadow and deflects to the left, possibly into the left hepatic vein which lies in this region. The migrated catheter was extracted using a snare by transjugular route.
Contributed By:
Dr. Iyappan Ponnuswamy MD, FRCR
Consultant Radiologist, Kauvery Hospital, Chennai