A 25 year-old patient with a Port-a-Cath implanted in the right chest complains of sudden onset severe neck pain and headaches with flushing central line and PN infusions. Labs and exam normal, including afebrile. Previous X-ray shows central line tip in at the cavo-atrial junction. Today, chest X-ray obtained (see below).
What is the most likely diagnosis?
The correct answer is c. Central line malposition. The central line tip is in the neck. Ultrasound with doppler is needed to determine whether the patient has thrombus associated with catheter malposition.
Seung WB, Kim DY, Kim JW, Park YS. Fatal septic internal jugular vein-sigmoid
sinus thrombosis associated with a malpositioned central venous catheter. J
Korean Neurosurg Soc. 2013 Mar;53(3):183-6. doi: 10.3340/jkns.2013.53.3.183. Epub 2013 Mar 31. PubMed PMID: 23634270; PubMed Central PMCID: PMC3638273.