Clinical Practice and Cases in Emergency Medicine

Introduction: The placement of central venous catheters (CVC) is a common procedure for the administration of chemotherapy. Adverse events include malposition or displacement; there are limited reports of misplaced implanted CVCs.

Case Report: A 59-year-old female with a history of recently diagnosed metastatic small cell lung cancer, hypertension, former tobacco use of over 60 pack-years, and chronic obstructive pulmonary disease without chronic hypoxemic respiratory failure presented to the emergency department following the first outpatient infusion of chemotherapy. She developed acute onset dyspnea, moderate respiratory distress, and hypoxemia. She was found to have a malpositioned subclavian implanted (ie, “port”) CVC that was placed under fluoroscopy the week prior with placement confirmed by chest radiograph. The evaluation revealed a large right pleural effusion secondary to unintentional intrapleural infusion of chemotherapy. The patient was transferred to a tertiary-care center with successful clinical improvement after drainage of the effusion via tube thoracostomy. 

Conclusion: We present an uncommon diagnosis of a chemothorax from a malpositioned central venous catheter in the thorax, despite a radiograph suggesting correct placement, and infusion of chemotherapy causing a common complaint of shortness of breath. This case highlights the limitations of radiographic confirmation of CVCs and a resultant complication from malpositioning.