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
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). Thrombus surrounding the tip of the catheter, 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 appears more hyperdense around the thrombus' margins, 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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