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  • Title: Perforation of the superior vena cava - a rare complication of central venous catheters.
    Author: Jost K, Leithäuser M, Grosse-Thie C, Bartolomaeus A, Hilgendorf I, Andree H, Casper J, Freund M, Junghanss C.
    Journal: Onkologie; 2008 May; 31(5):262-4. PubMed ID: 18497516.
    Abstract:
    BACKGROUND: Central venous catheters (CVC) guarantee a reliable venous access and are an indispensable part of the therapy in patients with hematologic malignancies. On the other hand, they contribute significantly to the therapy-related morbidity in this group of patients. The most common complications are catheter-associated infections or thromboses. Here we report on the rare, but potentially life-threatening case of a vessel wall perforation by a CVC. CASE REPORT: A 29-year-old female with newly diagnosed acute lymphoblastic leukemia had a CVC inserted via the left subclavian vein. After two weeks she complained about acute chest pain. Radiology revealed right-sided pleural effusion which was due to a vena cava superior vessel wall perforation by the CVC. Chemotherapy extravasation was excluded by pleural fluid analyses. CONCLUSION: A vessel wall perforation by a CVC is a rare and often late CVC complication with usually unspecific symptoms. Especially patients with leftsided, large-bore catheters are at risk. Awareness of this complication and immediate therapy are essential. We discuss the possible mechanisms and treatment options of this rare CVC complication.
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