A 43‐year‐old man on chronic intravenous antibiotic therapy presented with new‐onset chest pain that had developed while flushing his peripherally inserted central catheter (PICC) line. The pain was pleuritic in quality and was associated with chest tightness. His physical exam was unremarkable except for mild hypoxia on room air. Initial blood and cardiac enzyme studies, ECG, and chest radiography were normal. The results of a ventilation‐perfusion (V/Q) scan indicated a low probability of pulmonary embolism. The pain persisted, leading to a contrast CT of the chest. It revealed a fragmented portion of the PICC line in the distal branch of the right pulmonary artery extending proximally into the main pulmonary artery, right ventricle, and atrium. The catheter was retrieved percutaneous‐ly by interventional radiology using a transvenous snare, with the patient's symptoms subsequently resolving.
The use of PICC lines has increased over the last decade. These catheters require minimally invasive insertion and serve as a safe means of long‐term vascular access. They have a relatively low rate of complications, which include infection, mechanical obstruction, and thrombosis. Fracture and embolization, an uncommon occurrence, has rarely been reported in the general literature. We describe an unusual presentation of chest pain caused by PICC line fracture and embolization after antibiotic administration. The limited number of reviews of this topic have outlined that PICC line fracture and embolization may remain “silent” for years or may manifest with cardiac (chest pain, MI, arrhythmias, valvular perforation, and pericardial tamponade), thromboembolic, or infectious (sepsis and endocarditis) complications. The most likely mechanism described for fracture is “pinch‐off” syndrome, which may have occurred in our patient. In pinch‐off syndrome, the catheter fractures as a result of a combination of long‐term line compression between the clavicle and the first rib and increased stress on the catheter tip induced by port flushing. Our patient had no major complications, despite a delay in diagnosis, except for mild hypoxia, likely from V/Q mismatch. Catheter retrieval should always be attempted before thrombus and fibrosis formation occur, which cause significant morbidity. In our patient, the procedure was completed successfully with no further complications.
Fracture and embolization is a rare mechanical complication of PICC lines that may remain asymptomatic but should be considered by hospitalists whenever chest pain occurs after port flushing.
A. Chaaya, None; O. Nehme, None; W. Abou Zgheib, None; R. Kanaan, None; W. D. Surkis, None.
To cite this abstract:Chaaya A, Nehme O, Zgheib W, Kanaan R, Surkis W. Peripherally Inserted Central Catheter Fracture and Embolization: An Unusual Cause of Chest Pain. Abstract published at Hospital Medicine 2007, May 23-25, Dallas, Texas Abstract 114. Journal of Hospital Medicine. 2007; 2 (suppl 2). https://www.shmabstracts.com/abstract/peripherally-inserted-central-catheter-fracture-and-embolization-an-unusual-cause-of-chest-pain/. Accessed August 24, 2019.