PORT placement revisited…

October 20, 2012

Chest XR, Devices, Non-Trauma, XR


A couple days ago I posted a case of a guy with chest wall pain after PORT placement.  I posed the question:  “With a recent PORT placement, what complications can occur and specifically which problems are we looking for when we order a chest Xray?”

A PORT, or a Port-A-Cath (Smith’s Medical) is a long-term central line placed subcutaneously into a central vein to allow for frequent access.  Usually they are placed for chemotherapy administration, as was the case with the man I saw with the chest Xray shown several days ago.  As with any indwelling device or procedure, there are possible complication:

1. Thrombosis:  PORTs can be associated with venous clots and are a risk factor for SVC (Superior Vena Cava) Syndrome

2.  Infection:  infection of the line can cause life-threatening sepsis

3.  Bleeding:  can occur into the chest cavity as well as hematomas around the catheter.  Can be from subclavian vein or artery

4.  Pneumothorax:  the catheter is placed most-often in the left upper chest wall and, as with other central lines, pneumothorax can occur

5.  Mechanical failure:  breaking of the line or migration of the line can rarely occur

PORT-A-Catheters are generally safe and well tolerated.  It is important to know what you are looking for however if you are assessing them in the postoperative time period.  In our case, the chest Xray was obtained mainly to rule out #4 and #5 above.  There are subtle signs of #2 that can occur on chest Xray (such as multiple septic emboli or signs of heart failure from cardiac valvular infection) but generally line infections are a clinical diagnosis in conjunction with cultures from the line.  #1 is best worked up with a CT of the chest in the right clinical situation.  #3 is clinically rare outside of the immediately post-operative time period but if the man had a large pleural effusion on the side of the PORT this could indicate bleeding from the subclavian vein (or less likely artery).

I’ve included the picture again for your reference with the knowledge that it is normal, no findings suggestive of PORT complications.  Note the proper placement of the distal portion of the catheter in the SVC (red arrow):

The gentleman showed no signs of SVC syndrome and the pain was very reproducible.  It was attributed to post-operative pain and he was discharged in good condition.

If you are wondering, the patient does NOT have free air under the diaphragm.  This is his colon as demonstrated by the haustra visible and can sometimes be confused with free air.  This is referred to as Chilaiditi syndrome and occurs because of a transposition of the colon between the liver and the diaphragm.  His was unchanged from prior and is an incidental, non-clinically significant finding (1).

Author:  Russell Jones, MD

References

1.  Saber AA, Boros MJ.  Chilaiditi’s Syndrome:  what should every surgeon know?  Am Surg.  2005 Mar; 71 (3): 261-3.

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EMREMS: Radiology in Emergency Medicine

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  1. The LITFL Review 083 - Life in the Fast Lane - October 1, 2013

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