Posters
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Internal Medicine
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Internal Medicine
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Internal Medicine
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Abstract Type
Case Report
Abstract
Case: Chemothorax caused by a misplaced Port-A-Cath is an exceedingly rare complication of chemotherapy, with limited cases reported in the oncology literature. A 79-year-old woman with primary adenocarcinoma of the right lower lobe, status post-lobectomy, presented with fever, fatigue, and respiratory symptoms during chemotherapy. Initial evaluation revealed leukocytosis (WBC: 25000/uL), anemia (hemoglobin: 6.6 g/dL), and right middle lobe pneumonia with pleural effusion. Empirical antibiotics were initiated for healthcare-associated pneumonia (HAP) and urinary tract infection (UTI).
Given these findings, further diagnostic workup included thoracentesis, which removed 1,400 mL of milky pleural fluid. Fluid analysis revealed triglycerides of 392 mg/dL, giving an impression of chylothorax. Further fluoroscopic imaging subsequently demonstrated extravasation of contrast into the pleural cavity from a misplaced Port-A-Cath, presumed to have caused chemothorax during prior carboplatin and pemetrexed infusion. The catheter was surgically removed, and a second thoracentesis drained 1,450 mL of yellowish fluid. Endoscopy identified a 3 cm non-bleeding gastric ulcer as the source of anemia, which improved after transfusion. Concurrent new-onset atrial fibrillation (AF) with rapid ventricular response (HR: 145 bpm) was managed with metoprolol and amiodarone. A multidisciplinary team including pulmonology, cardiology, oncology, and surgery coordinated care.
Impact/Discussions: This case adds to the limited literature on chemothorax due to misplaced central catheters in chemotherapy patients, reinforcing the need for heightened vigilance. The diagnostic process involved a combination of imaging, fluid analysis, and clinical expertise, while the management required prompt surgical intervention and medical optimization. This case highlights the critical importance of maintaining a high index of suspicion for uncommoncomplications, such as chemothorax, when evaluating complex clinical presentations involving the use of central lines. Moreover, the diagnostic and management principles demonstrated here are essential in oncology and serve as a blueprint for addressing catheter-related complications in critical care and hospital medicine settings. It emphasizes the importance of timely diagnostic evaluation, coordinated specialty input, and patient-centered care in improving outcomes
Conclusion:
-Misplaced central catheters can lead to rare but severe complications, such as chemothorax, necessitating early recognition and intervention.
-Multidisciplinary collaboration ensures comprehensive management of complex complications, optimizing patient outcomes across diverse healthcare contexts.
-This case underscores the need for vigilance in catheter placement and monitoring, especially in oncology patients undergoing chemotherapy.
Recommended Citation
Kakarlapudi, Yasitha; Charu, Hasini Vasa; and Celias, Pantoja Rojas, "Chemothorax and Atrial Fibrillation: Multidisciplinary Management of Misplaced Port-A-Cath in a Lung Cancer" (2025). Research Symposium. 176.
https://scholarworks.utrgv.edu/somrs/2025/posters/176
Included in
Chemothorax and Atrial Fibrillation: Multidisciplinary Management of Misplaced Port-A-Cath in a Lung Cancer
Case: Chemothorax caused by a misplaced Port-A-Cath is an exceedingly rare complication of chemotherapy, with limited cases reported in the oncology literature. A 79-year-old woman with primary adenocarcinoma of the right lower lobe, status post-lobectomy, presented with fever, fatigue, and respiratory symptoms during chemotherapy. Initial evaluation revealed leukocytosis (WBC: 25000/uL), anemia (hemoglobin: 6.6 g/dL), and right middle lobe pneumonia with pleural effusion. Empirical antibiotics were initiated for healthcare-associated pneumonia (HAP) and urinary tract infection (UTI).
Given these findings, further diagnostic workup included thoracentesis, which removed 1,400 mL of milky pleural fluid. Fluid analysis revealed triglycerides of 392 mg/dL, giving an impression of chylothorax. Further fluoroscopic imaging subsequently demonstrated extravasation of contrast into the pleural cavity from a misplaced Port-A-Cath, presumed to have caused chemothorax during prior carboplatin and pemetrexed infusion. The catheter was surgically removed, and a second thoracentesis drained 1,450 mL of yellowish fluid. Endoscopy identified a 3 cm non-bleeding gastric ulcer as the source of anemia, which improved after transfusion. Concurrent new-onset atrial fibrillation (AF) with rapid ventricular response (HR: 145 bpm) was managed with metoprolol and amiodarone. A multidisciplinary team including pulmonology, cardiology, oncology, and surgery coordinated care.
Impact/Discussions: This case adds to the limited literature on chemothorax due to misplaced central catheters in chemotherapy patients, reinforcing the need for heightened vigilance. The diagnostic process involved a combination of imaging, fluid analysis, and clinical expertise, while the management required prompt surgical intervention and medical optimization. This case highlights the critical importance of maintaining a high index of suspicion for uncommoncomplications, such as chemothorax, when evaluating complex clinical presentations involving the use of central lines. Moreover, the diagnostic and management principles demonstrated here are essential in oncology and serve as a blueprint for addressing catheter-related complications in critical care and hospital medicine settings. It emphasizes the importance of timely diagnostic evaluation, coordinated specialty input, and patient-centered care in improving outcomes
Conclusion:
-Misplaced central catheters can lead to rare but severe complications, such as chemothorax, necessitating early recognition and intervention.
-Multidisciplinary collaboration ensures comprehensive management of complex complications, optimizing patient outcomes across diverse healthcare contexts.
-This case underscores the need for vigilance in catheter placement and monitoring, especially in oncology patients undergoing chemotherapy.
