title: Distal fragmented port catheter: case report and review of literature.
abstract: BACKGROUND
  Insertion of long-term central venous catheters (CVC) plays a vital role in providing continuous venous access for therapy in children. CVC line fractures are most commonly seen after long-term periods of therapy during removal. Usual place of rupture is proximal, at the point of entrance of the catheter into the vein, when the subclavian approach is utilized. We discuss a case that shows that CVC can also fracture in places different than the most common location and is possible not to detect that a fracture has occurred if a substantial portion of catheter is removed.
  
  
  METHODS
  We report a two-year-old child that was incidentally found to have a distal fragmented piece of CVC left after previous "successful" removal on simple chest films. At time of removal the catheter length was deemed properly. A CT Scan confirmed the suspected diagnosis. Fragment of catheter was successfully removed via femoral percutaneous endovascular technique.
  
  
  RESULTS
  CVC fractures can be suspected when there is resistance during removal or the length retrieved is too short. In this case the ease of retrieval and unusual site of rupture was the cause of not noticing that a part of catheter remained fixed to the vessel wall. Different potential mechanisms of CVC rupture include mechanical trauma, manufacturing defect or material degradation. Ruptures should be detected early to prevent complications such as sepsis, endocarditis, thrombosis, embolization, vessel stenosis and dysrhythmia. Best method to remove the fragmented catheter is via percutaneous endovascular retrieval method. After catheter removal a hyperdensity silhouette on a CXR can mimic the fragmented portion of a catheter known as a calcified cast or "ghost". To differentiate a "ghost" from an actual fragmented portion of catheter a CT Scan or echocardiogram is needed.
  
  
  CONCLUSIONS
  Most important single step in preventing such complication is to keep record of the patient length of catheter that was inserted to be able to measure it after removal confirming it still has the same length. Fragmented CVC should be removed using percutaneous endovascular techniques.
authors.affiliation: U.P.R. School of Medicine, Puerto Rico.
authors.forename: Norman E
authors.initials: NE
authors.lastname: Colón-Casasnovas
authors.forename: Humberto
authors.initials: H
authors.lastname: Lugo-Vicente