Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
권호 표지

Two Cases of Fractured and Embolized Implanted Central Venous Chemoports in Lung Cancer

폐암환자에서 발생한 피하매몰 중심정맥포트 골절 및 색전증 2예

  • Ju, Jin Yung (Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital) ;
  • Cho, Jae Yeong (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Lim, Jung Hwan (Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital) ;
  • Cho, Gye Jung (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Chae, Dong Ryeol (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Oh, In Jae (Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital) ;
  • Kim, Kyu Sik (Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital) ;
  • Kim, Yu Il (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Lim, Sung Chul (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Kim, Young Chul (Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital) ;
  • Song, Sang Yoon (Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital) ;
  • Na, Kook Ju (Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital) ;
  • Kim, Yun Hyun (Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital) ;
  • Kim, Jae Kyu (Department of Diagnostic Radiology, Chonnam National University Medical School)
  • 주진영 (화순전남대학교병원 폐식도 종양 클리닉) ;
  • 조재영 (전남대학교 의과대학 내과학교실) ;
  • 임정환 (화순전남대학교병원 폐식도 종양 클리닉) ;
  • 조계중 (전남대학교 의과대학 내과학교실) ;
  • 채동렬 (전남대학교 의과대학 내과학교실) ;
  • 오인재 (화순전남대학교병원 폐식도 종양 클리닉) ;
  • 김규식 (화순전남대학교병원 폐식도 종양 클리닉) ;
  • 김유일 (전남대학교 의과대학 내과학교실) ;
  • 임성철 (전남대학교 의과대학 내과학교실) ;
  • 김영철 (화순전남대학교병원 폐식도 종양 클리닉) ;
  • 송상윤 (화순전남대학교병원 폐식도 종양 클리닉) ;
  • 나국주 (화순전남대학교병원 폐식도 종양 클리닉) ;
  • 김윤현 (화순전남대학교병원 폐식도 종양 클리닉) ;
  • 김재규 (전남대학교 의과대학 영상의학교실)
  • Received : 2007.07.25
  • Accepted : 2007.10.11
  • Published : 2007.11.30
Download PDF
⟨ Previous Next ⟩

Abstract

Totally implanted central venous access devices for chemotherapy (chemoport) are being used increasingly in lung cancer patients. Vascular catheters are associated with various complications including infection, thrombosis as well as spontaneous fractures and embolization of the catheter, which is known as 'pinch-off syndrome'. 'Pinch-off syndrome' refers to the compression of a subclavian central venous catheter between the clavicle and first rib resulting in an intermittent or permanent obstruction, which can lead to tears, transection, or embolization. We report two cases of fractured and embolized implanted subclavian venous catheters in which the fragments were removed percutaneously. A 62-year-old man presented with back pain with a duration of a few weeks. The chest radiograph revealed complete transsection and embolization of the catheter into the right atrium. In addition, a 47-year-old woman with a chemoport had a grade 3 pinch-off sign in a chest radiograph demonstrating complete transsection and embolization of the catheter into the pulmonary artery. Both cases were managed by retrieving the embolized distal fragment percutaneously and removing the proximal section of the catheter.

항암제 치료 등을 위해서 피하매몰 중심정맥포트를 유치한 환자에서 도관 골절 및 원위부의 색전증은 드물게 발생하는 합병증으로 일반적인 경우는 경피적으로 도관의 제거가 가능하나, 임상의사들이 미리 이러한 합병증을 예측할 수 있는 임상적 및 방사선학적인 소견을 인지하고 조기에 발견하여 올바른 처치를 하는 것이 중요하며, 이러한 합병증을 예방하기 위한 방법 등에 대해서 숙지하는 것이 필요하다.

Keywords

References

  1. Rauthe G, Altmann C. Complications in connection with venous port systems: prevention and therapy. Eur J Surg Oncol 1998;24:192-9 https://doi.org/10.1016/S0748-7983(98)92963-8
  2. Yildizeli B, Lacin T, Baltacioglu F, Batirel HF, Yuksel M. Approach to fragmented central venous catheters. Vascular 2005;13:120-3 https://doi.org/10.2310/6670.2005.00053
  3. Hinke DH, Zandt-Stastny DA, Goodman LR, Quebbeman EJ, Krzywda EA, Andris DA. Pinch off syndrome: a complication of implantable subclavian venous access devices. Radiology 1990;177:353-6 https://doi.org/10.1148/radiology.177.2.2217768
  4. Kim OK, Kim SH, Kim JB, Jeon WS, Jo SH, Lee JH, et al. Transluminal removal of a fractured and embolized indwelling central venous catheter in the pulmonary artery. Korean J Intern Med 2006;21:187-90 https://doi.org/10.3904/kjim.2006.21.3.187
  5. Coles CE, Whitear WP, Le Vay JH. Spontaneous fracture and embolization of a central venous catheter: prevention and early detection. Clin Oncol (R Coll Radiol) 1998;10:412-4 https://doi.org/10.1016/S0936-6555(98)80047-2
  6. McMenamin EM. Catheter fracture: a complication in venous access devices. Cancer Nurs 1993;16:464-7
  7. Andris DA, Krzywda EA, Schulte W, Ausman R, Quebbeman EJ. Pinch-off syndrome: a rare etiology for central venous catheter occlusion. JPEN J Parenter Enteral Nutr 1994;18:531-3 https://doi.org/10.1177/0148607194018006531
  8. Prager D, Hertzberg RW. Spontaneous intravenous catheter fracture and embolization from an implanted venous access port and analysis by scanning electron microscopy. Cancer 1987;60:270-3 https://doi.org/10.1002/1097-0142(19870715)60:2<270::AID-CNCR2820600226>3.0.CO;2-S
  9. Lenglinger FX, Hartl P, Kirchgatterer A, Lenglinger GM, Baldinger C. Fracture and embolization of a central venous port catheter without prior compression between the clavicle and the 1st rib. Wien Klin Wochenschr 2001;113:134-7
  10. De Graaff JC, Bras LJ, Vos JA. Early transection of a central venous catheter in a sedated ICU patient. Br J Anaesth 2006;97:832-4 https://doi.org/10.1093/bja/ael255
  11. Mirza B, Vanek VW, Kupensky DT. Pinch off syndrome: case report and collective review of the literature. Am Surg 2004;70:635-44
  12. Orsi F, Grasso RF, Arnaldi P, Bonifacio C, Biffi R, Bellomi M, et al. Ultrasound guided versus direct vein puncture in central venous port placement. J Vasc Access 2000;1:73-7 https://doi.org/10.1177/112972980000100209