title: Spontaneous migration of a portacath into the azygos vein with subsequent development of a tracheo-azygos fistula.
abstract: Subcutaneous venous port or 'portacath' devices are widely used, especially in oncology patients. Several potential complications of portacath devices have been well documented. We report a rare case of the spontaneous migration of the tip of a portacath into the azygos vein, with subsequent development of a tracheo-azygos fistula. This resulted in the patient receiving a dose of chemotherapy agent and saline directly into his lungs, which ultimately contributed to his death a few weeks later. To our knowledge, there have been only 10 previously reported cases of inadvertent intrathoracic (mediastinal, pleural or pulmonary) extravasation of chemotherapy agent as a result of central venous catheter malposition or perforation; this is the second reported case of extravasation of chemotherapy agent as a result of migration of a portacath device into the azygos vein.
authors.affiliation: Department of Radiology, Tauranga Hospital, Tauranga, New Zealand.
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Andrews
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Chisholm
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001401:Azygos Vein / Q000002:abnormalities* / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000175:diagnosis / Q000209:etiology; D017809:Fatal Outcome; D005548:Foreign-Body Migration / Q000209:etiology*; D006801:Humans; D008297:Male; D011015:Pneumonia, Aspiration / Q000139:chemically induced* / Q000000981:diagnostic imaging; D011169:Portal Vein / Q000000981:diagnostic imaging; D011859:Radiography; D014132:Trachea / Q000098:blood supply; D017211:Treatment Failure; D016896:Treatment Outcome; D062666:Vascular Access Devices / Q000009:adverse effects*; D016157:Vascular Fistula / Q000175:diagnosis / Q000209:etiology*
chemical_list: D000970:Antineoplastic Agents
keywords: agent extravasation; antineoplastic agent; catheterization instrument; indwelling catheter; interventional; vein