内容紹介
A Case of Delayed Vascular Injury as a Complication Related to Implanted Central Venous Port Catheter
Summary
A 74-year-old woman with advanced gastric cancer was admitted to our hospital. A central venous(CV)port catheter was implanted into the right subclavian vein for preoperative chemotherapy and parenteral nutritional management. On the 35th day after implantation, she complained of diarrhea, fever and dyspnea. The chest radiograph showed a right-sided massive pleural effusion. As the patient progressively fell into severe respiratory distress, endotracheal intubation was performed for management of respiration by mechanical ventilation. Initially, given the patient's symptoms, she was diagnosed with septic shock. Therefore, after placement of a CV catheter through the right femoral vein, in consideration of the possibility of a port infection, she was treated with thoracentesis and infusion of antibiotics. The patient gradually recovered, and again received parenteral nutrition through the CV port catheter. After the infusion was administered, she complained of dyspnea. A CT scan of the chest revealed a right pleural effusion and displacement of the tip of the CV port catheter out of the wall of the superior vena cava. We diagnosed delayed vascular injury(DVI), and the CV port catheter was removed. She soon recovered with conservative treatment. We speculated that the initial respiratory symptoms such as the pleural effusion were caused by DVI. DVI should therefore be recognized as a complication related to implanted CV port catheters.
要旨
症例は74歳,女性。4型胃癌のため,術前化学療法および栄養管理を目的に右鎖骨下静脈より皮下埋め込み型中心静脈ポート(CVポート)を留置した。留置後35日目に突然,下痢,発熱および呼吸苦が出現し,胸部X線写真で右胸水を認めた。敗血症と考え治療を開始したが,しだいに呼吸不全に移行したため人工呼吸管理とした。また,ポート感染の可能性も考慮し,新たに右大腿静脈よりCVポートカテーテルを留置した。胸水の培養検査,細胞診では異常を認めなかったが,血液培養でBacillus cereusが検出された。その後,全身状態が改善した後に再びCVポートより補液を開始したところ,再度呼吸苦が出現し,胸部CTで右胸水とともにカテーテル先端の血管外への逸脱を認め,遅発性血管損傷と診断した。胸水穿刺,CVポート抜去後は速やかに症状の改善が得られたが,retrospectiveに検証すると,遅発性血管損傷とBacillus cereusによる敗血症が併存した症例と考えられた。遅発性血管損傷はまれではあるものの重篤化することが多く,CVポートカテーテル留置に伴う合併症の一つとして認識しておく必要がある。
目次
Summary
A 74-year-old woman with advanced gastric cancer was admitted to our hospital. A central venous(CV)port catheter was implanted into the right subclavian vein for preoperative chemotherapy and parenteral nutritional management. On the 35th day after implantation, she complained of diarrhea, fever and dyspnea. The chest radiograph showed a right-sided massive pleural effusion. As the patient progressively fell into severe respiratory distress, endotracheal intubation was performed for management of respiration by mechanical ventilation. Initially, given the patient's symptoms, she was diagnosed with septic shock. Therefore, after placement of a CV catheter through the right femoral vein, in consideration of the possibility of a port infection, she was treated with thoracentesis and infusion of antibiotics. The patient gradually recovered, and again received parenteral nutrition through the CV port catheter. After the infusion was administered, she complained of dyspnea. A CT scan of the chest revealed a right pleural effusion and displacement of the tip of the CV port catheter out of the wall of the superior vena cava. We diagnosed delayed vascular injury(DVI), and the CV port catheter was removed. She soon recovered with conservative treatment. We speculated that the initial respiratory symptoms such as the pleural effusion were caused by DVI. DVI should therefore be recognized as a complication related to implanted CV port catheters.
要旨
症例は74歳,女性。4型胃癌のため,術前化学療法および栄養管理を目的に右鎖骨下静脈より皮下埋め込み型中心静脈ポート(CVポート)を留置した。留置後35日目に突然,下痢,発熱および呼吸苦が出現し,胸部X線写真で右胸水を認めた。敗血症と考え治療を開始したが,しだいに呼吸不全に移行したため人工呼吸管理とした。また,ポート感染の可能性も考慮し,新たに右大腿静脈よりCVポートカテーテルを留置した。胸水の培養検査,細胞診では異常を認めなかったが,血液培養でBacillus cereusが検出された。その後,全身状態が改善した後に再びCVポートより補液を開始したところ,再度呼吸苦が出現し,胸部CTで右胸水とともにカテーテル先端の血管外への逸脱を認め,遅発性血管損傷と診断した。胸水穿刺,CVポート抜去後は速やかに症状の改善が得られたが,retrospectiveに検証すると,遅発性血管損傷とBacillus cereusによる敗血症が併存した症例と考えられた。遅発性血管損傷はまれではあるものの重篤化することが多く,CVポートカテーテル留置に伴う合併症の一つとして認識しておく必要がある。