Thrombus around central venous catheter tip

Case contributed by Dr Yair Glick

Presentation

Swelling of left neck and face. History of mastectomy and chemotherapy for breast cancer. Port catheter in situ for the past 7 years, not in use for several years.

Patient Data

Age: 60 years
Gender: Female

Previous left mastectomy. Surgical clips in both axillae.
Right internal jugular implantable port, its catheter tip in the upper 3rd of the superior vena cava (SVC) (i.e. too high). Around the tip, there is a thrombus involving the upper SVC (above the entrance of the azygos) and both brachiocephalic veins, also protruding into the entrance of the right internal thoracic vein. Contrast material is more hyperdense around the thrombus' margins, probably owing to stasis.
No evidence of cervical, axillary, or mediastinal lymphadenopathy.

Case Discussion

The central venous catheter (CVC) tip should be placed at the SVC-right atrial junction. In this case, it was in the upper 3rd of the SVC, which confers a 3-5x risk of deep vein thrombosis (DVT)1. If therapy via the catheter has been discontinued, it should be removed after 3-5 days of anticoagulation therapy 2.

New-onset symptoms and thrombus homogeneity in keeping with a fresh thrombus 3.

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Case information

rID: 55966
Case created: 3rd Oct 2017
Last edited: 6th Oct 2017
System: Vascular
Inclusion in quiz mode: Included
Institution: Hillel Yaffe Medical Center

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