gms | German Medical Science

Background: Venous access devices (port systems) are widely used especially for oncology patients in order to apply chemotherapy. Spontaneous port catheter fracture is rare. However it may lead to serious sequelae. On the other side it may remain subclinical for many years.

Materials and methods: We report the case of a 66-year old female patient who underwent a surgical resection due to rectal carcinoma. In order to administer the adjuvant chemotherapy she underwent an implantation of an intravenous port system. Because of postoperative dysfunction of the port device a second look had to be performed. Postoperatively a chest X-ray was routinely performed and showed a port catheter fragment in the right lower field. The patient refused a surgical therapy to remove the fractured catheter. Nine years later a routine oncologic follow-up per CT scan of the thorax was performed. It showed a central mass in the right lower lobe, which was later proven to be a pulmonary metastasis of the rectal adenocarcinoma. The fractured port catheter could be recognized on the CT scan in the subsegmental pulmonary artery of the right lower lobe.

Results: We performed an anterolateral thoracotomy with pulmonary metastasectomy and systematic lymph node dissection. Due to the central location of the tumor a right lower lobe resection had to be performed. The fractured port catheter was intraoperatively identified in the subsegmental pulmonary artery und could be completely removed.

Conclusion: Port catheter fracture can be spontaneous or iatrogenic and is in general a rare condition. The migration of the port catheter in the circulatory system can result in serious sequelae e.g. lung infarction, pulmonary embolism, stroke or peripheral vascular events. However, it can remain subclinical for many years and accidentally discovered as in our case. Surgical removal is the best therapeutic option. However, it sometimes requires an extended operative approach like a sternotomy.

Figure 1 [Fig. 1]