A case of mediastinitis caused by peripherally inserted central catheter

Abstract

A peripherally inserted central catheter is easier to insert and associated with a lower risk than a centrally inserted central catheter. Abscess formation and vessel perforation related to the catheter tip have been reported using both catheters. We encountered a case of mediastinitis caused by a peripherally inserted central catheter. Herein, we report this case.

A 60-year-old man complained of fever and difficulty eating during chemotherapy for hypopharyngeal carcinoma. A central catheter was peripherally inserted.

Although an antibacterial agent improved his fever and inflammatory findings temporarily, his condition worsened one week later. The catheter was removed 15 days after insertion because of obstruction. On the same day, computed tomography showed some findings of mediastinitis. We urgently performed thoracoscopic mediastinotomy and he recovered through intensive care.

There are 9 reported cases of mediastinitis caused by a central venous catheter including our case. Three of them were diagnosed as infectious mediastinitis and necessitated surgical treatment. If the mediastinitis is caused chemically by an anticancer agent or hyperalimentation, conservative therapy may be possible. However, if suspecting infectious mediastinitis, surgical treatment should be performed urgently.