CTICasesPort-A-Cath Lead Fracture and Intracardiac Migration
Imaging findings
Sequential chest radiographs show a port-a-cath that was previously in normal position with the catheter traversing the subclavian vein and SVC and the tip in the right atrium. On the current radiograph, the catheter has separated from the reservoir at the first rib-clavicle junction where it had been in place for 5 years, and the distal catheter fragment has migrated inferiorly into the right atrium.
Key takeaways
Port-a-cath catheter fracture with intracardiac migration is a recognized complication of long-standing indwelling central venous ports, particularly at the first rib-clavicle pinch point where mechanical stress from repeated subclavian compression can fatigue the catheter material over years. The diagnosis is readily made on chest radiograph by demonstrating that the radiopaque catheter is no longer continuous from the reservoir to the SVC/atrium. Retrieval via snare technique and port replacement are required. Fibrin sheath formation around the catheter can make positioning difficult and contribute to the mechanism of fracture.
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