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

Abstract

Subcutaneous venous port or 'portacath' devices are widely used, especially in oncology patients. Several potential complications of portacath devices have been well documented. We report a rare case of the spontaneous migration of the tip of a portacath into the azygos vein, with subsequent development of a tracheo-azygos fistula. This resulted in the patient receiving a dose of chemotherapy agent and saline directly into his lungs, which ultimately contributed to his death a few weeks later. To our knowledge, there have been only 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; this is the second reported case of extravasation of chemotherapy agent as a result of migration of a portacath device into the azygos vein.

Central venous catheter misplaced in the epidural space

“…Since three previous cycles of FOLFOX/bevacizumab were administered without toxicity, we postulate that the migration of the catheter tip into the epidural space occurred after the last chemotherapy cycle. There are other reports of catheter tip migration,2 but to our knowledge, only another one into the epidural space3 and one in the vertebral vein,4 in both cases after a jugular vein approach.…”

Immediate post‐insertion tip migration of peripherally inserted central catheters dependent on arm position and depth of inspiration

“…This is particularly important due to the risk related to migration into the azygos vein, 12,13 such as the recent reported fatal case of iatrogenic trachea-azygos fistula. 18 Furthermore, there is well-established risk of left-sided lines eroding the lateral wall of the SVC if placed within Zone B. 11 Since commencement of this study, Chopra et al 19 have published an international multispecialty panel consensus on appropriateness of intravenous catheters, in which intra-atrial position of all central venous catheters (including PICCs) is considered acceptable.…”

“…This is particularly important due to the risk related to migration into the azygos vein, such as the recent reported fatal case of iatrogenic trachea‐azygos fistula . Furthermore, there is well‐established risk of left‐sided lines eroding the lateral wall of the SVC if placed within Zone B …”

Misplacement of Tunneled Hemodialysis Catheter into Azygos Vein: Left or Right Jugular Insertion Has Similar Susceptibility

“…Misposition of CVC may lead to complications including perforation [10], venous thrombosis and occlusion [19,26], extravasation of infusate [27], retrosternal or back pain [19,28], and trachea-azygos fistula formation [29]. Risk factors related to unintended AV misplacement of CVCs include left-sided catheter insertion [10,11], use of catheter with long or separated venous tips [11], catheter placement in a patient with fluid overload (high central venous pressure) [10], and absence of real-time radiological guidance [5].…”