Sudhakar B G K, Teja B Ravi
Consultant Cardiologist, KIMS hospital, Secunderabad, Telangana 500003 India.
Fellow in cardiology, KIMS hospital, Secunderabad, Telangana, India.
Radiol Case Rep. 2021 Jun 16;16(8):2261-2265. doi: 10.1016/j.radcr.2021.03.064. eCollection 2021 Aug.
Catheter fracture with subsequent embolization is a well known but a potentially serious late complication of central venous catheter placement. Central venous catheters are frequently implanted for the purpose of chemotherapy and parenteral nutrition. Most common vein used for the placement of central venous catheter is subclavian vein. According to case reports, catheter placed in subclavian vein is vulnerable for fracture and is often preceded by the "pinch-off sign", first described by Aikten and Minton. It is due to shearing forces between the clavicle and first rib. Broken catheter frequently embolises to Right atrium, Right Ventricle, Inferior vena cava, Pulmonary arteries and rarely into Coronary sinus. Migration to Coronary sinus is very uncommon and only 5 cases are reported in the literature as of now. We are presenting an unusual case where chemoport catheter severed and lodged partly in coronary venous sinus and partly in right ventricle taking a "U "shape. Fragment was successfully retrieved percutaneously using a snare after straightening it with a pigtail catheter. Though majority of patients deny symptoms however, some do have symptoms or complications. Catheter fragment can lead to arrhythmias, thrombosis, infection and perforation. Thrombosis of coronary sinus is a life threatening complication. Regular follow up with Chest x ray may recognize the fracture and embolization much earlier. In almost all cases the migrated portion can be retrieved safely percutaneously without recourse to surgery.
导管断裂并继发栓塞是中心静脉导管置入术一种广为人知但潜在严重的晚期并发症。中心静脉导管常因化疗和肠外营养的目的而植入。用于置入中心静脉导管最常用的静脉是锁骨下静脉。根据病例报告，置于锁骨下静脉的导管易发生断裂，且常先出现“Aikten和Minton首次描述的‘夹闭征’”。这是由于锁骨和第一肋骨之间的剪切力所致。断裂的导管常栓塞至右心房、右心室、下腔静脉、肺动脉，很少进入冠状窦。迁移至冠状窦非常罕见，截至目前文献中仅报道了5例。我们现报告一例不寻常的病例，化疗端口导管断裂，部分位于冠状静脉窦，部分位于右心室，呈“U”形。在用猪尾导管将其拉直后，使用圈套器经皮成功取出碎片。尽管大多数患者无相关症状，但也有一些患者确实出现症状或并发症。导管碎片可导致心律失常、血栓形成、感染和穿孔。冠状窦血栓形成是一种危及生命的并发症。定期进行胸部X线检查随访可更早发现导管断裂和栓塞情况。几乎在所有病例中，迁移的部分均可经皮安全取出，无需进行手术。
