PMC9360527_01
Chest x-ray showing a large right pleural effusion with abnormal position of the distal tip of the Port-a-Cath.
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F1
Chest x-ray showed a right pleural effusion with suspected abnormal position of the distal tip of the Port-a-Cath (Figure 1).
Axial (A), coronal (B), and sagittal (C) chest CT scans showing a large right pleural effusion, complete atelectasis of the lower lobe of the right lung, the proximal tip of the central venous catheter placed tangentially to the right subclavian vein, and the catheter (white arrows) located outside the superior vena cava, reaching with the distal tip the middle mediastinum at the level of the body of D6.
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F2
Thus, we performed chest CT, which allowed to demonstrate the wrong placement of the proximal tip of the catheter, placed tangentially to the right subclavian vein, while the catheter was located outside the superior vena cava, reaching with the distal tip the middle mediastinum at the level of the body of D6; a large right pleural effusion and complete atelectasis of the lower lobe of the right lung were also present (Figure 2).
Surgical removal of the Port-a-Cath by triportal video-assisted thoracic surgery (VATS): visualization of the central venous catheter located in the pleural cavity, anteriorly to the right subclavian vessels, and running along the superior vena cava.
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F3
After the first administration of the antidote, the patient underwent surgical removal of the Port-a-Cath by triportal VATS under general anesthesia: this procedure enabled the visualization of a diffuse parietal pleura hyperemia and of the central venous catheter located in the pleural cavity, anteriorly to the right subclavian vessels, and which ran along the superior vena cava (Figure 3).
Surgical removal of the Port-a-Cath by triportal VATS: the central venous catheter of the Port-a-Cath is slowly removed, without bleeding, under safe guidance of the thoracoscopic view.
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F4
Subsequently, the subcutaneous reservoir was surgically retrieved at the level of the right pectoral region and the central venous catheter of the Port-a-Cath was slowly removed, without bleeding, under safe guidance of the thoracoscopic view (Figure 4).