1. MedPix Medical Image Database COW - Case of the Week Case Contributor: Fred R Brandon Affiliation: National Capital Consortium

2. MedPix No: 4359 - History Pt Demographics: Age = 40 y.o. Gender = woman 40-year-old female with metastatic colon cancer receiving chemotherapy through a left arm port in place for 6 months. Patient states that last two chemo treatments have caused burning in her arm. Downloaded by (-1)

3. MedPix No: 4359 - EXAM & LABS

4. Ruptured arm med port with extravation Under fluoroscopic guidance, contrast material was then injected into the - port. Immediately noted was a small amount of extravasation of contrast - material around the proximal catheter, approximately 1 cm distal to the - junction with the port. The visualized catheter and port appear to be well - joined on multiple fluoroscopic views. However, there is definite - extravasation of contrast at the proximal aspect of the catheter. Viewing the - distal tip of the catheter, contrast was seen to exit rapidly from the - catheter tip in the superior vena cava just near the right atrial junction Downloaded by (-1)

5. Ruptured arm med port with extravation Under fluoroscopic guidance, contrast material was then injected into the - port. Immediately noted was a small amount of extravasation of contrast - material around the proximal catheter, approximately 1 cm distal to the - junction with the port. The visualized catheter and port appear to be well - joined on multiple fluoroscopic views. However, there is definite - extravasation of contrast at the proximal aspect of the catheter. Viewing the - distal tip of the catheter, contrast was seen to exit rapidly from the - catheter tip in the superior vena cava just near the right atrial junction Downloaded by (-1)

6. FINDINGS Under fluoroscopic guidance, contrast material was then injected into theport. Immediately noted was a small amount of extravasation of contrastmaterial around the proximal catheter, approximately 1 cm distal to thejunction with the port. The visualized catheter and port appear to be welljoined on multiple fluoroscopic views. However, there is definiteextravasation of contrast at the proximal aspect of the catheter. Viewing thedistal tip of the catheter, contrast was seen to exit rapidly from thecatheter tip in the superior vena cava just near the right atrial junction.No kinking or other obstruction to flow could be identified, including cloton the tip of the catheter. Therefore, it is unlikely that this scenariorepresents a pseudofracture of the catheter caused by contrast tracking backalong the catheter due to obstruction from a clot on the tip.

7. DIFFERENTIAL DIAGNOSIS What is your Differential Diagnosis? Ruptured arm med port with extravation. - -

8. Diagnosis: Ruptured arm med port with extravation Dx Confirmed by:

9. DISCUSSION Implant able ports are constructed from various materials and used for long tern venous access. A Huber needle is inserted through the skin into the port. These ports may be placed in the arm or chest. Complications may be divided into early and late: - - Early complications include, pneumothorax, arterial puncture, hemorrhage, hematoma along with catheter malposition and perforation. - - Late complication includes, infection (most common), catheter occlusion, venous thrombosis and catheter migration/ fracture and wound dehiscence. - - Prevention of complications include proper imaging while placement of the catheter, sterile technique, insuring near normal labs such as platelets and bleeding time. The daily proper care and wound care. If the catheter malfunctions it may be either removed or if continued access is required replacement in either the same vein over a wire or another site may be used. -