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Virtual Pediatric Hospital: Thoracopaedia: An Imaging Encyclopedia of Pediatric Thoracic Disease: Case 45 Thoracopaedia: An Imaging Encyclopedia of Pediatric Thoracic Disease

Case 45

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed

Chief Complaint:
Eleven year old male with a central line

Clinical History:
This is an 11 year old male with autoimmune polyglandular syndrome who has a central venous line. The old line was exchanged for a new line and a post line placement film was obtained.

Clinical Physical Exam:

Clinical Labs:

Clinical Differential Diagnosis:
Not applicable

Imaging Findings:
The post line replacement film showed the tip of the new line to be in satisfactory position in the superior vena cava. A catheter fragment, from the old line, was noted in the right lower lobe. It was presumed to have been sheared off during the exchange and embolized into the pulmonary artery. This finding was not clearly communicated to the clinical service and the patient was discharged without further treatment. The patient presented 5 months later with back pain. Plain films of the spine (not provided) again demonstrated the embolized catheter fragment, and a chest CT exam showed the catheter to have eroded into the pleural space.

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Imaging Differential Diagnosis:
Embolized catheter fragment.

Operative Findings:
A pleural tap revealed a large right hemothorax. The patient underwent a wedge resection of the right lower lobe in order to remove the catheter fragment.

Pathological Findings:
Pathological examination of the surgical specimen revealed a fragment of catheter.

Final Diagnosis:
Embolized Catheter Fragment

Follow-up and Prognosis:
The patient had an uncomplicated post-operative course and improved rapidly after the operation.

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