Presentation
Haemoptysis, infective endocarditis. CTPA to exclude septic emboli to lungs and pulmonary embolism.
Patient Data
Three lead pacemaker and a defibrillator are in situ; the pressure rated, right-sided PICC line is within the superior vena cava and appropriate for injection.
Pulmonary embolus in the right interlobar pulmonary artery extends all the way to the right lower lobe arterial branches. There is also embolus in the anterior segmental branches of the right upper lobe and the subsegmental upper lobe branches of the right and left upper lobes.
The PICC line has flicked into the right internal jugular vein, at the moment this is not appropriate to use.
The initial image demonstrates the PICC in the right internal jugular vein. New PICC line has been placed with the tip confirmed at cavoartial junction.
Case Discussion
Dislodgment of pressure rated PICC line post-contrast-enhanced CT is a known complication (8-15%) 1,2 of power-injected intravenous contrast media. It is postulated that this is due to the saline flush during the contrast injection causing a sudden change in the viscosity leading to dislodgement.
It is a useful protocol to check the PICC before and afterwards via a low dose axial acquisition (similar to a HRCT) to ensure the PICC is safe to use.
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