Presentation
PICC not flushing or aspirating. ?fibrin sheath
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.
Case Discussion
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.
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