Baciarello Marco, Maspero Giada, Maestroni Umberto, Palumbo Giuseppina, Bellini Valentina, Bignami Elena
Anesthesiology, Critical Care and Pain Medicine Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy.
Second Unit of Anesthesia, Critical Care and Pain Medicine, University Hospital of Parma, Parma, Italy.
J Vasc Access. 2020 Jul;21(4):529-532. doi: 10.1177/1129729819873488. Epub 2019 Sep 16.
Fibroblastic sheath formation is a well-known complication of long-term central venous catheters. When calcified, fibroblastic (formerly known as "fibrin") sheaths may be easily mistaken for retained catheter fragments. We describe one such case and how imaging was used to recognize the sheath and avoid unnecessary interventions.
A patient with systemic sclerosis was referred for port removal because of suspected infection. A later computed tomography scan showed a persistent tubular structure coursing behind the right clavicle, which was also seen in an anteroposterior chest radiograph. Three-dimensional reconstruction and analysis of the structure's lumen in comparison to previous imaging studies allowed us to confirm that it was, in fact, a calcified fibroblastic sheath. The patient's course was uneventful thereafter.
Three-dimensional computed tomography reconstruction, as well as the hollow appearance of a tubular structure after removal of a central catheter may help differentiate a fibroblastic sheath from a retained catheter fragment. Accurate surgical notes mentioning the length of the catheter at implant and explant are also of paramount importance.
纤维母细胞鞘形成是长期中心静脉导管的一种常见并发症。当发生钙化时，纤维母细胞（以前称为“纤维蛋白”）鞘可能很容易被误认为是残留的导管碎片。我们描述了这样一个病例，以及如何利用影像学来识别鞘并避免不必要的干预。
一名系统性硬化症患者因疑似感染而被转诊进行端口移除。后来的计算机断层扫描显示，在右锁骨后方有一个持续的管状结构，在胸部前后位X线片上也可见到。通过三维重建并与之前的影像学研究对比分析该结构的管腔，我们得以确认它实际上是一个钙化的纤维母细胞鞘。此后患者病情平稳。
三维计算机断层扫描重建，以及中心导管移除后管状结构的中空外观，可能有助于将纤维母细胞鞘与残留的导管碎片区分开来。准确记录植入和取出时导管长度的手术记录也至关重要。
