Procedure: Chest port contrast evaluation with thrombolytic infusion

Indication: pt with nonfunctional surgically placed chest port

Operators: Drs. 

Port site:  right chest 

Contrast: 10 cc nonionic

Medications: 4 mg TPA in 100 mL normal saline infused over 2 hours

Complications: None immediate

 

Technique: The risks, benefits, and alternatives to the procedure were explained to the patient. The specific risk of remote bleeding was discussed and accepted. The patient denies contraindications to thrombolytic therapy.

The existing right chest port and surrounding soft tissues were prepped and draped in sterile fashion. Access was achieved with a Huber needle. Fluoroscopy was utilized to confirm appropriate location in 2 orthogonal planes.

Contrast was then injected with imaging over the port reservoir and throughout the course of the catheter. A digital subtraction venogram was performed over the tip centrally.

The catheter was flushed and the patient was transferred to the holding area. There, a 4 mg, 2 hour thrombolytic infusion was carried out.

After after the infusion was complete, catheter function was re-tested. There was prompt return of blood, indicating full restoration of function. The catheter was flushed and heparinized. The port was de-accessed and dressed. The patient was discharged in satisfactory condition.

 

Findings:

  1. The port reservoir is intact.  
  2. There is no evidence for contrast extravasation or early pinch off.
  3. [] fibrin sleeve is present at the catheter tip.
  4. The port could not be aspirated.
  5. After 4 mg t-PA infusion, the port was easily aspirated.

 

Impression: 

[] chest port dysfunction secondary to fibrin sheath.

The port function was fully restored with the thrombolytic infusion.

The attending radiologist,    , was present for the procedure and interpreted the images.