Pulmonary embolization of PICC fibrin sheath
Citation, DOI, disclosures and case data
At the time the case was submitted for publication Maciej Debowski had no recorded disclosures.View Maciej Debowski's current disclosures
PICC not flushing or aspirating. ?fibrin sheath
Loading Stack -
0 images remaining
Preliminary image shows an appropriately positioned PICC with subtle increased opacity along its tip.
Fluoroscopy was performed while flushing the PICC with iodinated contrast.
The first few frames demonstrate contrast filling the fibrin sheath which appears as a thickening along the distal PICC. There is no contrast exiting from the tip of the PICC but instead contrast is seen to leak out from the top of the fibrin sheath at the level of the carina.
The fibrin sheath then slides off the PICC, transits through the heart, and lodges within the right lower lobe.
Patient was asymptomatic during and after the procedure. CT-PA confirmed a sub-segmental PE however this did not require treatment.
Case courtesy of Dr Himanshu Thalagala.