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Retained Fibrin Sheaths: Chest Computed Tomography Findings and Clinical Associations

Krausz, David J. MD*,†; Fisher, Jessica S. MD*; Rosen, Galia MD; Haramati, Linda B. MD, MS*,§; Jain, Vineet R. MD*; Burton, William B. PhD; Godelman, Alla MD*; Levsky, Jeffrey M. MD, PhD*; Taragin, Benjamin H. MD*; Cynamon, Jacob MD*; Aviram, Galit MD

doi: 10.1097/RTI.0b013e318299ff22
Original Articles

Purpose: Fibrin sheaths may develop around long-term indwelling central venous catheters (CVCs) and remain in place after the catheters are removed. We evaluated the prevalence, computed tomographic (CT) appearance, and clinical associations of retained fibrin sheaths after CVC removal.

Materials and Methods: We retrospectively identified 147 adults (77 men and 70 women; mean age 58 y) who underwent CT after CVC removal. The prevalence of fibrin sheath remnants was calculated. Bivariate and multivariate analyses were performed to assess for associations between sheath remnants and underlying diagnoses leading to CVC placement; patients’ age and sex; venous stenosis, occlusion, and collaterals; CVC infection; and pulmonary embolism.

Results: Retained fibrin sheaths were present in 13.6% (20/147) of cases, of which 45% (9/20) were calcified. Bivariate analysis revealed sheath remnants to be more common in women than in men [23% (16/70) vs. 5% (4/77), P=0.0018] and to be more commonly associated with venous occlusion and collaterals [30% (6/20) vs. 5% (6/127), P=0.0001 and 30% (6/20) vs. 6% (7/127), P=0.0003, respectively]. Other variables were not associated. Multivariate analysis confirmed the relationship between fibrin sheaths and both female sex (P=0.005) and venous occlusion (P=0.01).

Conclusions: Retained fibrin sheaths were seen on CT in a substantial minority of patients after CVC removal; nearly half of them were calcified. They were more common in women and associated with venous occlusion.

Departments of *Radiology


Family and Social Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx

Department of Radiology, Staten Island University Hospital, Staten Island, NY

Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

G.A. is a consultant at Activiews Ltd and Algotec - a Carestream Company. J.C. is a consultant at Foresight imaging, lectures for Genentech and receives royalties from angiodynamics; his daughter is employed by Delcath. L.B.H.'s husband is a board member of Orthospace Kryon and Bioprotect. The remaining authors declare no conflicts of interest.

Reprints: Linda B. Haramati, MD, MS, Department of Radiology and Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210 Street, Bronx, NY 10467 (e-mail:

© 2014 by Lippincott Williams & Wilkins