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Current Medical Imaging

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ISSN (Print): 1573-4056
ISSN (Online): 1875-6603

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Case Report

Calcified Fibrin Sheath Embolism of Bilateral Pulmonary Arteries: A Second Case of the Literature

Author(s): Abdi Gürhan* and Abidin Kılınçer

Volume 19, Issue 12, 2023

Published on: 14 February, 2023

Article ID: e230123213051 Pages: 4

DOI: 10.2174/1573405619666230123154146

Price: $65

Abstract

Introduction/Background: Central venous catheters, which provide a unique convenience in the management of critical patients, have many advantages, as well as early and late complications. Early complications include pneumothorax, vascular perforation, hematoma formation, air embolism, or catheter malposition that may occur during or shortly after catheter insertion. Late complications include infection, venous stenosis, catheter thrombosis, and catheter tip migration. In the literature, embolization of a calcified fibrin sheath due to a central venous catheter to the pulmonary artery has been reported only in one case.

Case Presentation: The purpose of this report is to present bilateral pulmonary artery embolism in a patient who presented with cough and chest pain caused by calcified fibrin sheath of the port catheter removed before that was used for regular chemotherapeutic infusions due to liposarcoma, as the second case in the literature with imaging findings. The patient underwent medical treatment, and as a result of the treatment, symptoms regressed.

Conclusion: Central venous catheters have many complications, and although it is rare, pulmonary embolism is one of them. The embolism of a calcified sheath is even rare, but it is still possible. However, an embolism can cause significant morbidity and even mortality for a patient if it occurs. As physicians, we should be aware of this entity to diagnose.

Keywords: Calcified fibrin sheath embolism, non-thrombotic pulmonary embolism, central venous catheter, retained fibrin sheath, chest CT, PICCs.

Graphical Abstract

[1]
Ganeshan A, Warakaulle DR, Uberoi R. Central venous access. Cardiovasc Intervent Radiol 2007; 30(1): 26-33.
[http://dx.doi.org/10.1007/s00270-006-0021-z] [PMID: 16933156]
[2]
Ruesch S, Walder B, Tramèr MR. Complications of central venous catheters: Internal jugular versus subclavian access—A systematic review. Crit Care Med 2002; 30(2): 454-60.
[http://dx.doi.org/10.1097/00003246-200202000-00031] [PMID: 11889329]
[3]
Savio R, Jagathkar G, Pandit RA, et al. Indian Society of Critical Care Medicine Position Statement for Central Venous Catheterization and Management 2020. Indian J Crit Care Med 2020; 24 (Suppl. 1): S6-S30.
[http://dx.doi.org/10.5005/jp-journals-10071-G23183] [PMID: 32205954]
[4]
Iovino F, Pittiruti M, Buononato M, Lo Schiavo F. Central venous catheterization: Complications of different placements. Ann Chir 2001; 126(10): 1001-6.
[http://dx.doi.org/10.1016/S0003-3944(01)00653-8] [PMID: 11803622]
[5]
McGee DC, Gould MK. Preventing complications of central venous catheterization. N Engl J Med 2003; 348(12): 1123-33.
[http://dx.doi.org/10.1056/NEJMra011883] [PMID: 12646670]
[6]
Alomari AI, Falk A. The natural history of tunneled hemodialysis catheters removed or exchanged: A single-institution experience. J Vasc Interv Radiol 2007; 18(2): 227-35.
[http://dx.doi.org/10.1016/j.jvir.2006.12.719] [PMID: 17327555]
[7]
Hoshal VL Jr, Ause RG, Hoskins PA. Fibrin sleeve formation on indwelling subclavian central venous catheters. Arch Surg 1971; 102(4): 353-8.
[http://dx.doi.org/10.1001/archsurg.1971.01350040115023] [PMID: 5553297]
[8]
Xiang DZ, Verbeken EK, Van Lommel ATL, Stas M, De Wever I. Composition and formation of the sleeve enveloping a central venous catheter. J Vasc Surg 1998; 28(2): 260-71.
[http://dx.doi.org/10.1016/S0741-5214(98)70162-4] [PMID: 9719321]
[9]
Keehn A, Rabinowitz D, Williams SK, Taragin BH. Calcified central venous catheter fibrin sheath: Case report and review of the literature. Clin Imaging 2015; 39(6): 1130-3.
[http://dx.doi.org/10.1016/j.clinimag.2015.07.014] [PMID: 26259863]
[10]
Lu A, Smith DC. Calcified fibrin sheath masquerading as retained catheter. J Vasc Interv Radiol 2013; 24(5): 691.
[http://dx.doi.org/10.1016/j.jvir.2012.01.071] [PMID: 22440589]
[11]
Anderson MAB, Poenaru D, Kamal I. Calcified catheter “cast”: A rare complication of indwelling central venous catheters in infants. Pediatr Surg Int 1998; 13(8): 610-2.
[http://dx.doi.org/10.1007/s003830050418] [PMID: 9799390]
[12]
Krausz DJ, Fisher JS, Rosen G, et al. Retained fibrin sheaths: Chest computed tomography findings and clinical associations. J Thorac Imaging 2014; 29(2): 118-24.
[http://dx.doi.org/10.1097/RTI.0b013e318299ff22] [PMID: 23846108]
[13]
Chopra V, Anand S, Hickner A, et al. Risk of venous thromboembolism associated with peripherally inserted central catheters: A systematic review and meta-analysis. Lancet 2013; 382(9889): 311-25.
[http://dx.doi.org/10.1016/S0140-6736(13)60592-9] [PMID: 23697825]
[14]
Brismar BO, Hårdstedt C, Jacobson S. Diagnosis of thrombosis by catheter phlebography after prolonged central venous catheterization. Ann Surg 1981; 194(6): 779-83.
[http://dx.doi.org/10.1097/00000658-198112000-00021] [PMID: 7305496]
[15]
Winn M, McDermott V, Schwab S, Conlon P. Dialysis catheter ‘fibrin-sheath stripping’: A cautionary tale! Nephrol Dial Transplant 1997; 12(5): 1048-50.
[http://dx.doi.org/10.1093/ndt/12.5.1048] [PMID: 9175070]
[16]
Rockoff MA, Gang DL, Vacanti JP. Fatal pulmonary embolism following removal of a central venous catheter. J Pediatr Surg 1984; 19(3): 307-9.
[http://dx.doi.org/10.1016/S0022-3468(84)80194-3] [PMID: 6747797]
[17]
Rousslang LK, Wood JR. Rare case of a calcified catheter-related sheath embolizing to the right pulmonary artery. Case Rep Radiol 2020; 2020: 1-3.
[http://dx.doi.org/10.1155/2020/8623538] [PMID: 32518702]
[18]
Unal E, Balci S, Atceken Z, Akpinar E, Ariyurek OM. Nonthrombotic pulmonary artery embolism: Imaging findings and review of the literature. AJR Am J Roentgenol 2017; 208(3): 505-16.
[http://dx.doi.org/10.2214/AJR.16.17326] [PMID: 27824484]
[19]
Matusik PS. Łoboda P, Krzanowska K, Popiela TJ, Heba G, Pawlik W. Presence of retained calcified fibrin sheath after central venous catheter removal: A systematic literature review. J Vasc Access 2022; 23(4): 644-52.
[http://dx.doi.org/10.1177/1129729820969328] [PMID: 33143527]
[20]
Roy D, Wenxiang Y, Pande SD. A calcified central venous fibrin sheath mimicking a fractured catheter. Semin Dial 2020; 33(4): 343-4.
[http://dx.doi.org/10.1111/sdi.12887] [PMID: 32530097]

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