Transluminal Removal of a Fractured and Embolized Indwelling Central Venous Catheter in the Pulmonary Artery
A 39-year-old woman with a 10-year history of liposarcoma had an implantable intravenous access devices (Celsite ST 201, 8.5 Fr, B/Braun medical Inc, France) placed in the left subclavian area, using the standard technique, to allow the administration of adjuvant chemotherapy. Three-months after implantation of the intravenous access device, the patient complained of chest and jaw pain for several days; she denied palpitations, dyspnea and syncope. There was no jugular venous distension. Cardiac auscultation revealed a regular rate and rhythm without any murmur, gallops or rubs; a normal S1 and S2 was present. The chest X-ray two months prior to presentation showed a grade two "pinch-off sign" () and the chest X-ray on admission showed a fractured and embolized catheter in the pulmonary artery (). Several days later, transesophageal echocardiography was performed and revealed no thrombus and spontaneous echo contrast in the right side of the heart and pulmonary artery. Computed tomography of the chest confirmed the catheter artifact in the pulmonary artery ().\nFirst a retrieval of the fractured fragment of the catheter was attempted via the right femoral vein with a goose neck snare (10 mm loop, er3, USA) an H1 catheter (5 Fr, Cook, USA). Although we could grasp the foreign body using a snare, it was impossible to retrieve it; the patient continued to complain of severe chest and jaw pain. We, therefore, changed the catheter with a pigtail catheter (5 Fr, Cook, USA). With accompanying fluoroscopic monitoring, we were able to successfully grasp the fragmented catheter () and to retrieve it ().\nAt a Three-month follow up the patient was doing well without any complication detected.