van Bastelaar James, Janssen Caroline H C, de Bont Eveline, Blijlevens Nicole M, van Baren Robertine
Department of Paediatric Surgery, University Medical Center Groningen, PO Box 30,001, 9700, RB, Groningen, The Netherlands.
J Med Case Rep. 2012 Jul 2;6:180. doi: 10.1186/1752-1947-6-180.
Pericatheter calcifications are unusual and rare after removal of indwelling central venous catheters with few reports in the literature. We present a case of a woman with calcifications in her left innominate vein after removal of an implantable venous device.
A venous access port was surgically placed for intravenous chemotherapy in a 19-year-old Caucasian woman who had been diagnosed with acute lymphoblastic leukemia. She developed a fever three and a half years after placement, and the venous access port was removed as it was seen as the only focus for her fever. In the year following its removal, a computed tomography scan was ordered due to a clinical suspicion of deep venous thrombosis of her left arm. The computed tomography scan revealed a hyperdense structure in the left innominate vein with thrombosis. It was concluded that this was a foreign body, a retained catheter fragment after removal of the catheter. After three-dimensional reconstructions were performed, it was determined that these hyperdense structures were calcifications in the left innominate vein that resembled a foreign body.
Differentiating between intravenous thrombotic calcification and a retained catheter tip after removal can be challenging, even with modern day diagnostic tools. Care should be taken to document the length of the catheter upon placement and upon removal. In this manner, unnecessary surgical exploration can be avoided. We would like to highlight the importance of these diagnostic considerations for radiologists and oncologists.
留置中心静脉导管拔除后发生导管周围钙化的情况并不常见且极为罕见，文献报道较少。我们报告一例女性患者，在植入式静脉装置拔除后左无名静脉出现钙化。
一名19岁的白种女性被诊断为急性淋巴细胞白血病，因静脉化疗接受了静脉通路港植入手术。植入三年半后她出现发热，由于静脉通路港被视为发热的唯一病灶，遂将其拔除。拔除后的一年里，因临床怀疑其左臂深静脉血栓形成，进行了计算机断层扫描。计算机断层扫描显示左无名静脉内有一个高密度结构伴有血栓形成。结论是这是一个异物，即导管拔除后残留的导管碎片。进行三维重建后，确定这些高密度结构是左无名静脉内类似异物的钙化。
即使使用现代诊断工具，区分静脉血栓性钙化和拔除后残留的导管尖端也具有挑战性。放置和拔除导管时应注意记录导管长度。通过这种方式，可以避免不必要的手术探查。我们想强调这些诊断注意事项对放射科医生和肿瘤科医生的重要性。
