Two cases of venous perforation following central venous catheterization: efficacy of contrast imaging to detect the location of central venous catheter tip

Abstract

Central venous catheters (CVCs) have improved the safety of chemotherapy for malignant diseases, but complications include catheter infection, thrombophlebitis and fluid extravasation. We describe two patients with childhood acute leukemia and massive fluid extravasation that occurred during CVC management and who developed sudden chest pain and breathing difficulties. The CVCs were inserted at the left upper arm in both patients and problems occurred within one month thereafter. Contrast-imaging findings confirmed the absence of direct communication between the CVC tip and the pleural cavity in both patients, implying that massive bleeding was unlikely to occur after CVC removal. Identifying the precise location of the CVC tip by contrast radiography allowed for the selection of an appropriate treatment strategy for patients with CVC-related complications such as fluid extravasation.