Perforation of the superior vena cava - a rare complication of central venous catheters.
BACKGROUND
Central venous catheters (CVC) guarantee a reliable venous access and are an indispensable part of the therapy in patients with hematologic malignancies. On the other hand, they contribute significantly to the therapy-related morbidity in this group of patients. The most common complications are catheter-associated infections or thromboses. Here we report on the rare, but potentially life-threatening case of a vessel wall perforation by a CVC.


METHODS
A 29-year-old female with newly diagnosed acute lymphoblastic leukemia had a CVC inserted via the left subclavian vein. After two weeks she complained about acute chest pain. Radiology revealed right-sided pleural effusion which was due to a vena cava superior vessel wall perforation by the CVC. Chemotherapy extravasation was excluded by pleural fluid analyses.


CONCLUSIONS
A vessel wall perforation by a CVC is a rare and often late CVC complication with usually unspecific symptoms. Especially patients with leftsided, large-bore catheters are at risk. Awareness of this complication and immediate therapy are essential. We discuss the possible mechanisms and treatment options of this rare CVC complication.
Jost
Kirsten
K
Abteilung Hämatologie/Onkologie, Klinik für Innere Medizin, Universität Rostock, Germany.
Leithäuser
Malte
M
Grosse-Thie
Christina
C
Bartolomaeus
Anne
A
Hilgendorf
Inken
I
Andree
Holger
H
Casper
Jochen
J
Freund
Mathias
M
Junghanss
Christian
C
D000328:Adult; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D035583:Rare Diseases / Q000209:etiology / Q000628:therapy; D014683:Vena Cava, Superior / Q000293:injuries*; D014950:Wounds, Penetrating / Q000209:etiology* / Q000628:therapy*