Migração para veia hepática de cateter totalmente implantável para quimioterapia em paciente com carcinoma de mama: relato de caso / Hepatic vein migration of a totally implantable venous access port-a-cath for chemotherapy in a breast carcinoma patient: case report

Resumo O cateter totalmente implantável (CTI) é utilizado na administração da quimioterapia. Em menos de 1% dos casos de complicação, pode ocorrer migração do CTI para quimioterapia para a circulação sistêmica. O objetivo deste estudo foi descrever um caso de migração do CTI para a veia hepática. Uma paciente do sexo feminino, de 44 anos de idade, teve diagnóstico de câncer de mama com indicação de quimioterapia neoadjuvante. Realizou-se a implantação de cateter port-a-cath. Durante o procedimento de punção do cateter, houve retorno normal de sangue, e foi realizada infusão de soro fisiológico. Em seguida, houve um aumento de volume no local do port e não retorno de sangue à aspiração. A radiografia de tórax mostrou embolização do cateter em topografia hepática. Retirou-se o cateter pela técnica do laço (sem complicações), e a paciente recebeu alta no dia seguinte. Possíveis alterações no funcionamento do CTI devem chamar atenção da equipe responsável.

Abstract A totally implantable venous access port (TIVAP) is used for chemotherapy administration. Venous port migration to the systemic circulation occurs in less than 1% of complications. The aim of this study is to describe a case of TIVAP migration to the hepatic vein. A 44-year-old female patient with breast cancer was prescribed neoadjuvant chemotherapy. A port-a-cath was surgically implanted for chemotherapy. During the port puncture procedure, blood returned normally when aspirated. When the port was first accessed and flushed with saline solution, swelling was observed at the port site and blood could no longer be aspirated. A chest radiography showed catheter embolization in the region of the hepatic vein. The catheter was retrieved using a snare technique (without complications) and the patient was discharged the next day. The care team should be alert to possible TIIVAP malfunction.

Dispositivo intrauterino intravesical en expulsión en embarazo de tercer trimestre: reporte de un caso / Intravesical migration of intrauterine device in a pregnant woman

Se estima que en el mundo cerca de 160 millones de mujeres son usuarias de dispositivos intrauterinos (DIU), siendo Chile uno de los países con más alta tasa, con cerca del 70 por ciento de las usuarias en el sistema público. Sin embargo, su uso no está exento de complicaciones. Presentamos un caso infrecuente de DIU intravesical en expulsión en gestante de 28 semanas.

In the world, about 160 million women are users of intrauterine devices (IUD); Chile is one of the countries with the highest rate, with about 70 percent of users in public system. However, its use may be complications. We present an unusual case of intravesical IUD expulsion in 28 weeks pregnant.

Distal fragmented port catheter: case report and review of literature

BACKGROUND: Insertion of long-term central venous catheters (CVC) plays a vital role in providing continuous venous access for therapy in children. CVC line fractures are most commonly seen after long-term periods of therapy during removal. Usual place of rupture is proximal, at the point of entrance of the catheter into the vein, when the subclavian approach is utilized. We discuss a case that shows that CVC can also fracture in places different than the most common location and is possible not to detect that a fracture has occurred if a substantial portion of catheter is removed. METHOD: We report a two-year-old child that was incidentally found to have a distal fragmented piece of CVC left after previous "successful" removal on simple chest films. At time of removal the catheter length was deemed properly. A CT Scan confirmed the suspected diagnosis. Fragment of catheter was successfully removed via femoral percutaneous endovascular technique. RESULTS: CVC fractures can be suspected when there is resistance during removal or the length retrieved is too short. In this case the ease of retrieval and unusual site of rupture was the cause of not noticing that a part of catheter remained fixed to the vessel wall. Different potential mechanisms of CVC rupture include mechanical trauma, manufacturing defect or material degradation. Ruptures should be detected early to prevent complications such as sepsis, endocarditis, thrombosis, embolization, vessel stenosis and dysrhythmia. Best method to remove the fragmented catheter is via percutaneous endovascular retrieval method. After catheter removal a hyperdensity silhouette on a CXR can mimic the fragmented portion of a catheter known as a calcified cast or "ghost". To differentiate a "ghost" from an actual fragmented portion of catheter a CT Scan or echocardiogram is needed. CONCLUSION: Most important single step in preventing such complication is to keep record of the patient length of catheter that was inserted...

Central line retrieval in a neonate.

Peripherally inserted central lines are important for management of newborns in intensive care. 1% of PICC lines can migrate. Here we describe a preterm baby with a migrated PICC line enmeshed on the pulmonary valve. This was retrieved by snare from the pulmonary valve. The technique is described as also the challenges related to doing this in a small baby.

Migración de clip quirúrgico a la vía biliar común después de cirugía laparascópica de la vesícula / Metallic clip migration to the common bile duct after laparospic surgery of the gallbladder

Se presenta un paciente masculino, 65 años, con cuadro clínico de subictericia y colangitis, aparecido 8 meses después de colecistectomía laparascópica. En TC se observó un clip metálico intracoledociano, alojado por migración a partir del conducto cístico. La TC permitió un diagnóstico de certeza, procediéndose a papilotomía y extracción del cuerpo extraño