Fibrin sheath

Case contributed by Dr Henry Knipe

Presentation

Port implanted for chemo. Able to flush, not able to aspirate.

Patient Data

Age: 25 years
Gender: Male
DSA (angiography)

Portogram

Port was accessed in a sterile technique and contrast injected with mild resistance. Line tip is in the SVC with no kink of discontinuation.

On injection there is loss of normal jet from the tip with retrograde flow superiorly close to the catheter. 

Case Discussion

These findings are typical of fibrin sheath - this is the most common complication of any long-dwelling central venous catheter. It often forms a one-way valve effect with the presentation of "port/line flushes but does not aspirate" being quite typical. 

There are a number of treatment options including fibrinolysis, catheter exchange over wire or angiographic stripping. 

PlayAdd to Share

Case information

rID: 46734
Published: 15th Jul 2016
Last edited: 23rd Oct 2019
Inclusion in quiz mode: Included