CTICasesMalpositioned Port Catheter with Delayed Chemotherapy Extravasation into the Pleural Space
Imaging findings
A surgically placed left-sided port catheter is seen terminating near the midline on its initial post-placement radiograph, in a location that a colleague flagged as ambiguous. Three months later, after the patient had been receiving chemotherapy elsewhere through the same catheter, imaging obtained for new acute chest pain showed a large pleural effusion with the catheter tip located within the pleural space near the midline, anterior to its expected position.
Key takeaways
Despite early concern about the catheter's atypical course and termination point, and reported blood return during use, the catheter was in fact malpositioned within the pleural space from the outset, and chemotherapy infused through it produced a delayed presentation of chest pain and a large pleural effusion. The case reinforces that an atypical catheter course should prompt confirmation of intravascular position before use, regardless of reported blood return.
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