Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed
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 Differential Diagnosis:
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.
Imaging Differential Diagnosis:
Embolized catheter fragment.
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 examination of the surgical specimen revealed a fragment of catheter.
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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