Malpositioned chest port

Case contributed by Dr Jayanth Keshavamurthy

Presentation

History of colon cancer. Metastases to lungs and abdomen with right mid back/chest increased pain today.

Patient Data

Age: 50 years
Gender: Male
X-ray

Right chest port with tip that previously terminated in the distal SVC now overlies right jugular vein with tip terminating above the field-of-view.

X-ray

Prior chest radiograph

There is a right IJ Port-A-Cath with the tip overlying the distal SVC.
 

Case Discussion

Indication:
52-year-old male with right chest port and catheter in the right internal jugular vein. Catheter tip is now malpositioned projecting superiorly in the right internal jugular vein. Patient's white count
is mildly elevated 11.3 and replacement of the port catheter was deferred due to risk of infection.

Technique:
Informed consent was obtained; the patient was placed on the examination table in supine position; team verification of patient identification, procedure, and site was performed. Fluoroscopic image of the port catheter in the right chest wall was obtained. The patient was prepped and draped in usual sterile fashion. Lidocaine was infiltrated into the soft tissue. Skin incision was made superficial to the port. The port was freed from the surrounding soft tissues using a combination of blunt and sharp dissection. The port was removed intact under fluoroscopic guidance. An image was saved after reported removal. The port pocket was closed using interrupted 2-0 Vicryl suture deep and 4-0 Vicryl suture, subcuticular. Dermabond skin closure at the port pocket incision site; wounds were dressed in usual sterile fashion. The patient tolerated the procedure well.

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Case information

rID: 56516
Case created: 6th Nov 2017
Last edited: 7th Nov 2017
Inclusion in quiz mode: Included
Institution: Augusta University

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