Necrotizing pneumonitis caused by 5-fluorouracil infusion. A complication of a hickman catheter

Abstract

The authors report the case of a patient with a Hickman catheter that migrated into the lung parenchyma. The resultant inadvertent infusion of 5‐fluorouracil caused necrotizing chemical pneumonitis. Possible mechanisms of catheter migration include the lateral orientation of the catheter tip and the partial thrombosis of the innominate vein and superior vena cava. The patient recovered but had residual contraction fibrosis of the right upper lobe of the lung. Cancer 1992; 70:554‐556.

Spontaneous migration of a portacath into the azygos vein with subsequent development of a tracheo‐azygos fistula

“…This case represents a more exceptional and rare complication. There have been 10 previously reported cases of inadvertent intrathoracic (mediastinal, pleural or pulmonary) extravasation of chemotherapy agent as a result of central venous catheter malposition or perforation, and a further three cases of intrathoracic extravasation of non‐chemotherapy agent . In the majority of these cases, the catheter tip had eroded through the superior vena cava …”

“…[13][14][15] In the majority of these cases, the catheter tip had eroded through the superior vena cava. 4,5,[7][8][9]11,12,14 There is one previously documented case of migration of the catheter tip into the azygos vein, with subsequent inflammatory infiltration into the peritracheal space, tracheal necrosis and right upper lobe abscess formation following administration of chemotherapy agent; this patient survived following surgical management. 10 It is postulated that occlusion of the small-calibre azygos vein by the catheter and subsequent thrombosis, or ulceration of the vein wall due to continuous infusion of chemotherapy at the same point in the vessel, may have contributed to erosion and extravascular migration of the catheter tip.…”

Mediastinal extravasation of doxorubicin

“…This practice may involve infectious, thrombotic and mechanical complications such as catheter fragmentation, migration of the tip, obstruction due to fibrosis and fragment embolisation [3,4]. Extravasation of chemotherapy agents into the thorax is a very rare complication; only ten cases are reported in the literature, including this one [5][6][7][8][9][10][11][12][13]. All cases were caused by vesicant agents.…”

“…Both cases evolved as vena cava syndromes after catheter thrombosis and retrograde extravasation of the chemotherapy agent [5]. In 1991 and 1992 two cases involving 5-fluorouracil were reported, in which the agent caused pericardial effusion and cardiac arrhythmia in one case, and necrotising chemical pneumonitis in the other [6,7]. During the last decade four cases of mediastinitis, caused by vinblastine [8], epirubicine-5-fluorouracil [9], daunorubicine [10] and epirubicine [11] have been reported.…”