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Case Reports
. 2022 Jul 26:9:921968.
doi: 10.3389/fsurg.2022.921968. eCollection 2022.

Case report: Successful multimodal assessment and management of chemothorax

Teodora Panza  1 , Rosatea Quercia  1 , Francesca Signore  1 , Giulia De Iaco  1 , Debora Brascia  1 , Doroty Sampietro  1 , Anna Rita Gasbarro  2 , Maria Dell'Aera  2 , Vito Lorusso  3 , Giuseppe Marulli  1 , Angela De Palma  1
Affiliations
Case Reports

Case report: Successful multimodal assessment and management of chemothorax

Teodora Panza et al. Front Surg. .

Abstract

Dislocation or wrong placement of central venous catheters into the pleural cavity is rare, but if undiagnosed, may cause major, sometimes life-threatening, complications (pneumothorax, hemothorax, infection, and migration) and accidental pleural effusion due to intravenous injection of fluids containing drugs (i.e. chemotherapy, antibiotics, parenteral nutrition, other). We report a rare case of pleural effusion consisting of chemotherapy (chemothorax) directly injected into the pleural cavity due to the wrong placement of a central venous catheter (Porth-A-Cath) in a woman with breast cancer. A multidisciplinary management consisting of antidote administration, followed by removal of the venous device and washing of the pleural cavity through video-assisted thoracic surgery (VATS), avoided any major complication related to the adverse event.

Keywords: Port-A-Cath; chemotherapy; chemothorax; dislocation; multidisciplinary management; pleural effusion; thoracoscopy; video-assisted thoracic surgery.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Chest x-ray showing a large right pleural effusion with abnormal position of the distal tip of the Port-a-Cath.
Figure 2
Figure 2
Axial (A), coronal (B), and sagittal (C) chest CT scans showing a large right pleural effusion, complete atelectasis of the lower lobe of the right lung, the proximal tip of the central venous catheter placed tangentially to the right subclavian vein, and the catheter (white arrows) located outside the superior vena cava, reaching with the distal tip the middle mediastinum at the level of the body of D6.
Figure 3
Figure 3
Surgical removal of the Port-a-Cath by triportal video-assisted thoracic surgery (VATS): visualization of the central venous catheter located in the pleural cavity, anteriorly to the right subclavian vessels, and running along the superior vena cava.
Figure 4
Figure 4
Surgical removal of the Port-a-Cath by triportal VATS: the central venous catheter of the Port-a-Cath is slowly removed, without bleeding, under safe guidance of the thoracoscopic view.
See this image and copyright information in PMC

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References

    1. Boutin C, Viallat JR, Cargnino P, Farisse P. Thoracoscopy in malignant pleural effusions. Am Rev Respir Dis. (1981) 124:588–92. 10.1164/arrd.1981.124.5.588 - DOI - PubMed
    1. Medford ARL, Awan YM, Marchbank A, Rahamim J, Unsworth-White J, Pearson PJK. Diagnostic and therapeutic performance of videoassisted thoracoscopic surgery (VATS) in investigation and management of pleural exudates. Ann R Coll Surg Engl. (2008) 90:597–600. 10.1308/003588408X318246 - DOI - PMC - PubMed
    1. Celik M, Halezaroglu S, Senol C, Keles M, Yalcin Z, Urek S, et al. Video-assisted thoracic surgery: experience with 341 cases. Eur J Cardiothorac Surg. (1998) 14:113–6. 10.1016/S1010-7940(98)00167-5 - DOI - PubMed
    1. Kelly D, Geottman D, Sarodia B. Chemothorax: a rare cause of a transudative pleural effusion. BMJ Case Rep. (2015) 2015:bcr2015212691. 10.1136/bcr-2015-212691 - DOI - PMC - PubMed
    1. Wu CY, Fu JY, Feng PH, Liu YH, Wu CF, Kao TC, et al. Risk factors and possible mechanisms of intravenous port catheter migration. Eur J Vasc Endovasc Surg. (2012) 44:82–7. 10.1016/j.ejvs.2012.03.010 - DOI - PubMed

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