PMC6243363_01
Initial chest and abdominal plain radiograph showing the tip of the PICC at the T9 level (arrow).
bjrcr.20150327.g001.jpg
PMC6243363_01_bjrcr.20150327.g001.jpg
fig1
Initial chest and abdominal X-ray showed that the tip of the line was at T9 level with no coiling (Figure 1).
Dedicated oblique view of the left groin confirmed that a knot had formed at the distal peripherally inserted central venous catheter (arrow), preventing its removal through the calf entry site. The linear opacities projecting over the soft tissues of the thigh were due to overlying dressing and clothing.
bjrcr.20150327.g002.jpg
PMC6243363_01_bjrcr.20150327.g002.jpg
fig2
The X-ray confirmed our suspicion of a knot approximately 2.5 cm from the tip of the PICC (Figure 2).
Magnified view of the pelvis from the abdominal plain radiograph demonstrated in-folding of the peripherally inserted central venous catheter (arrow) at the left common and external iliac veins, which was probably the cause of the knot formation.
bjrcr.20150327.g003.jpg
PMC6243363_01_bjrcr.20150327.g003.jpg
fig3
When resistance was felt upon removal attempt, an earlier abdominal X-ray demonstrated folding of the distal end of the PICC upon itself in the left common iliac vein (Figure 3).
Image captured from low radiation dose fluoroscopy during transjugular retrieval of PICC demonstrated that the microsnare (outlined arrow) secured the distal peripherally inserted central venous catheter (PICC) into a microcatheter (solid arrow ) in the left external iliac vein. The knot of the PICC was seen distally outside the microcatheter (triangular arrow).
bjrcr.20150327.g004.jpg
PMC6243363_01_bjrcr.20150327.g004.jpg
fig4
The tip of the PICC was successfully snared with no difficulty (Figure 4).
(a) The peripherally inserted central venous catheter (PICC) with knot (arrow). (b) Magnified image of the PICC with knot.
bjrcr.20150327.g005.jpg
PMC6243363_01_bjrcr.20150327.g005.jpg
fig5
The remaining PICC was retrieved through the jugular sheath uneventfully (Figure 5a,b).