Spontaneous rupture of chemotherapy catheter diagnosed using chest X-ray oblique projections: An interventional radiology approach

Abstract

Totally implanted central venous port systems are widely used to access central veins for patients needing long-term therapy. These devices have low rates of complications and are commonly used to administer medications like chemotherapeutic agents. Spontaneous rupture of a catheter segment is a rare mechanical complication, usually belatedly diagnosed and presenting with complications. We present a case of a spontaneously ruptured chemotherapy catheter diagnosed using a novel approach via oblique projections on chest X-rays and successfully removed using an endovascular approach.

Keywords: Catheter fracture; Catheter rupture; Chemotherapy catheter; Chest X-ray; Endovascular treatment; PA, Posteroanterior; Pinch-off syndrome.

Fig. 1

Chest X-ray in PA (A) and lateral (B) projections showing an image suggestive of rupture of the chemotherapy catheter at the level of the left clavicle and the outer border of the first left rib (orange arrow). The distal segment of the catheter is lodged in the right ventricle (blue arrows).

Fig. 2

Chest X-rays right (A) and left (B) oblique projections confirming the rupture of the catheter (orange arrows) with its distal segment lodged in the right ventricle (blue arrows).

Fig. 3

Fluoroscopy guided procedure depicting the sequential process to remove the distal segment of the catheter (A-F). Images showing the distal segment of the chemotherapy catheter (white arrows), pigtail catheter (yellow arrow), guidewire (red arrow), guiding catheter (purple arrows), and snare loop (black arrows).