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Discovery of a Catheter Tip From a Subcutaneous Port in the Trachea

Morel, Vincent M.D.; Delaval, Philippe M.D.; LeCoz, A. M.D.


*Service de Pneumologie

Center Cardio-Pneumologique

Center Hospitalier Universitaire

Rennes, France

Service de Pneumologie

Center Hospitalier de Bretagne Sud

Lorient, France

To the Editor:

A 58-year-old woman with rectal adenocarcinoma (classified initially as T3N0M0) began surgical treatment, radiotherapy, and chemotherapy administered by means of a peripheral catheter in February 1998. One year later, a single hepatic metastasis was discovered. Administration of the chemotherapy was facilitated in February 1999 by placement of a subcutaneous infusion port, with its catheter extending into the upper vena cava from the right internal jugular vein. The patient underwent right hepatectomy and received six courses of chemotherapy without complication until November 1999. In May 2000, bone metastases were discovered. On the first administration of pamidronate sodium using the subcutaneous infusion port, cough and bronchial obstruction developed. Bronchoscopic exploration revealed that the tip of the catheter had perforated the vein and entered the lower trachea (Fig. 1). With the patient under local anesthesia and using bronchoscopic guidance, the catheter was withdrawn by pulling on the subcutaneous port. In this situation, should any bleeding or an air embolism occur, a endotracheal tube inserted through the bronchoscope can be positioned alongside the hole left by the catheter tip and can be inflated. Removal of the catheter was uneventful. Six months later, the patient is doing well. This is the first description of this complication of an implantable subcutaneous infusion port. 1–4 We recommend removal of the catheter using bronchoscopic guidance.

FIG. 1.

FIG. 1.

Vincent Morel, M.D.

Philippe Delaval, M.D.

A. LeCoz, M.D.

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© 2002 Lippincott Williams & Wilkins, Inc.