Presentation
History of metastatic gastric cancer on systemic chemotherapy with FOLFOX.
Patient Data
- The right-sided port a cath terminating in the region of SVC/RA junction is in the appropriate position.
- The gastroesophageal stent is stable in this patient with known metastatic gastroesophageal junction adenocarcinoma.
- Heart is normal in size without pulmonary vascular congestion. No discrete effusions or pneumothorax. No acute osseous findings in this patient with known osseous metastatic disease. No free air in the upper abdomen.
Case Discussion
An esophageal stent is surgical tube, or catheter, placed from the oropharynx and deployed in the esophagus. This structural support helps maintain the patency of the esophagus and is an option for those with dysphagia. A life-threatening complication of dysphagia is a regurgitation of food and aspiration pneumonia. One of the most common reasons for dysphagia needing gastroesophageal stenting is gastric cancer, as in this patient.
Stents are made of a metal mash which can be uncovered, partially or fully covered 1. The more metal is exposed, the greater the risk of granulation and tumor growth; fully covered stents have no metal exposed but are more prone to migration. Partially covered stents only expose a small amount of metal at the distal ends, decreasing migration 2. Another advancement has been self-expanding metal stents (SEMS), which are the most chosen method 3.
Possible complications of stent placement include hemorrhage, GERD, pneumonia, perforation and sepsis; the mortality rate for stent placement is 9% and the decision to do is not taken lightly. Given the additional complications of stent migration, especially in gastric cancer 3, the role of esophageal stenting in gastroesophageal cancer is currently for palliative control of dysphagia.
The device visualized in the right upper chest is a Port-a-cath, a central venous catheter (CVC) with a reservoir implanted subcutaneously to allow for long-term delivery of chemotherapy.
This case was submitted with supervision and input from:
Soni C Chawla, M.D.
Health Sciences Clinical Professor,
Department of Radiological Sciences,
David Geffen School of Medicine at UCLA.
Attending Radiologist,
Olive View - UCLA Medical Center.