[Fracture and embolization of a central venous port catheter without prior compression between the clavicle and the 1st rib]

Area of Science:

• Cardiology
• Radiology
• Thoracic Surgery

Background:

• Central venous port catheters inserted infraclavicularily are susceptible to compression by the clavicle and first rib.
• This compression can lead to the 'pinch-off phenomenon,' a known risk factor for catheter fracture and removal.

Observation:

• A case of central venous port catheter fracture occurred without preceding signs of the pinch-off phenomenon.
• The fractured catheter fragment migrated to the right atrium, causing pericardial effusion.

Findings:

• Initial attempts at percutaneous fragment removal were unsuccessful.
• Surgical intervention, specifically open heart surgery with cardiopulmonary bypass, was required for fragment removal.
• A myocardial lesion caused by the catheter fragment was successfully sutured.

Implications:

• Catheter fracture can occur even without the classic 'pinch-off phenomenon' on chest x-ray.
• Complex cases may require advanced surgical techniques for fragment retrieval.
• This case highlights the potential for serious cardiac complications from catheter embolization.