Infusothorax-chemothorax

Case contributed by Dr Jayanth Keshavamurthy

Presentation

66 year-old female with metastatic breast cancer; yellow fluid being aspirated from portacath.

Patient Data

Age: 66
Gender: Female
X-ray
  1. Large right pleural effusion, likely malignant in nature, patient will benefit from thoracentesis and Pleurx catheter placement.
  2. Bilateral multiple metastatic nodules.
  3. With above history a radiologist should think out of the box for rare complications of a portacath placement. Recommend a fluoro study for evaluation of tip of portacath as the tip on lateral view suggests it has an extrapleural course or it has perforated the SVC and is out into the mediastinum.
Fluoroscopy


The catheter of the right chest port has an extravascular course for its entire length and the tip of the catheter terminates in the  mediastinum/pleural space. The contrast flows into the posterior right pleural space.

 

CT

A right chest wall port has been placed. The catheter nor the catheter tip is intravascular, and terminates along the posterior medial aspect of the right thorax. There was a new development of a large fluid collection within the right hemithorax, which may represent a large right infusothorax from chemotherapy.

Case Discussion

The portacath was placed in OR under fluro guidance by surgeons. No static image was obtained post operatively.

Patient received chemotherapy via the port for 8 weeks. Despite this there has been good response to chemo therapy by the breast cancer.

Following the Chest X-Ray, fluoroscopy confirmed extravascular pleural course of portacath and confirmed on CT. The next day VATS performed and the port was removed; the pleural effusion was not bloody. At that time it was confirmed that the port was in pleural place all along and the chemotherapy was absorbed by the pleural membrane into blood stream effectively.

Important lesson: It is very important to ensure ports are intravascular by aspirating blood before infusing drugs. 

 

 

PlayAdd to Share

Case information

rID: 41567
Case created: 8th Dec 2015
Last edited: 5th Jan 2016
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.