CASE 10869 Published on 23.04.2013
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Dislocation of an unfractured port catheter into the right ventricle

Section

Cardiovascular

Case Type

Clinical Cases

Authors

Matteo Revelli1, Francesco Paparo2, Lorenzo Bacigalupo2

1 University of Genova, School of Radiology
2 Unit of Radiology, Ospedali Galliera, Genova
Connected authors
Patient

56 years, male

Categories
Area of Interest Cardiac ; Imaging Technique CT
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Clinical History
A 56-year-old man with a 2-year-history of rectal cancer underwent placement of a port-a-cath system to allow the administration of chemotherapy agents. One year later the patient presented to our institution complaining of chest pain, palpitations and shortness of breath.
Imaging Findings
A plain radiographic study of the chest was performed: it showed no signs of phlogistic processes (Fig. 1). Patient was hospitalised to perform further investigations and he underwent a CT examination of the chest, showing the dislocation and embolisation of the tip of the port catheter into the right ventricle (Fig. 2); VR reconstructed images confirmed the dislocation of the catheter (Fig. 3). The port-a-cath system was then removed and it showed no sign of rupture.
Discussion
Dislocation of a port catheter into the jugular vein occurs in a low percentage of cases, and malposition in other vessels has been reported even more rarely. Common causes of dislocation of the distal tip of venous catheters are fluctuations of intrathoracic pressure, surgical procedures such as thoracotomy or even heavy coughing. Several symptoms may be a manifestation of this condition and a few cases have been reported, such as a case of late embolisation of an unfractured port catheter into the heart [1], a case of catheter fracture and migration into the coronary sinus [2], going to a case of ventricular tachycardia secondary to port-a-cath fracture and embolisation [3] and even to a complete atrioventricular block due to venous stent migration from innominated vein to right ventricle [4] or to a positional ventricular tachycardia from a fractured mediport catheter with right ventricular migration [5]. In most cases a chest X-ray can give the diagnosis, but with unspecific findings a chest CT may be necessary. In conclusion, it is important to be aware of the possibility of this complication, especially considering the increasing number of port-a-cath systems’ implantation.
Differential Diagnosis List
Dislocation of an unfractured port catheter into the right ventricle
Hearth diseases
Pneumonia
Final Diagnosis
Dislocation of an unfractured port catheter into the right ventricle
Case information
URL: https://www.eurorad.org/case/10869
DOI: 10.1594/EURORAD/CASE.10869
ISSN: 1563-4086
Figure 1

Chest X-ray

Chest X-ray
Plain radiographic study of the chest, with no evidence of anomalies. The presence of a port-a-cath system was recorded.
Figure 2

Chest CT

Chest CT
Axial CT image of the chest, showing the dislocation of the tip of the port catheter in the right ventricle (arrow).
Chest CT
Coronal reformatted CT image of the chest, showing the dislocation of the tip of the port catheter in the right ventricle (arrow).
Chest CT
Sagittal reformatted CT image of the chest, showing the dislocation of the tip of the port catheter in the right ventricle (arrow).
Figure 3

Volume Rendering CT

Volume Rendering CT
Volume rendering reconstructed CT images, confirming the dislocation of the tip of the port catheter in the right ventricle (arrow in A and B).