SHM Converge Scientific Abstract ePoster Gallery-Mediport(dys)phagia - Mediport Tip Migration Into Internal Jugular Vein

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This case describes a 25-year-old man with recurrent seminoma receiving BEP chemotherapy who developed sudden dry cough, shortness of breath, dysphagia, and odynophagia after eating. Because he was neutropenic and immunocompromised, the initial differential included infection, pharyngitis, mechanical obstruction, medication-related pneumonitis, and other causes of swallowing difficulty.<br /><br />Examination was largely benign, but chest X-ray revealed an important finding: the distal tip of his Mediport catheter had migrated abnormally into the right internal jugular vein. CT angiography excluded pulmonary embolism. Interventional Radiology successfully retrieved and repositioned the catheter tip to the cavoatrial junction using a Kumpe catheter and ensnare device.<br /><br />His symptoms resolved after repositioning, and he tolerated a regular diet. The authors propose that the port tip likely irritated the vagus nerve in the carotid sheath, causing referred throat and swallowing symptoms. They note that catheter tip migration can present with neck, shoulder, ear pain, dysphagia, neurologic symptoms, thrombophlebitis, or no symptoms at all.<br /><br />Reported risk factors include left-sided catheters, changes in thoracic pressure such as straining or weight lifting, high-flow infusion, and congestive heart failure. The key lesson is that new cough, dyspnea, odynophagia, or dysphagia in a patient with a Mediport should prompt consideration of spontaneous catheter tip migration into the internal jugular vein.

Asset Subtitle

Harjinder Kumar

Meta Tag

Author List Harjinder Kumar

Category Clinical Vignettes

Concept Indwelling Device

Concept Catheter Tip Migration

Concept Internal Jugular Vein

Concept Catheter Repositioning

Concept Central Venous Catheterization

Distinguished Non-Finalist

Presenter Organization Walter Reed National Medical Center

Presenting Author Harjinder Kumar

Track Adult

Keywords

seminoma

BEP chemotherapy

Mediport catheter

catheter tip migration

internal jugular vein

dysphagia

odynophagia

dry cough

shortness of breath

interventional radiology

Indwelling Device

Catheter Tip Migration

Internal Jugular Vein

Catheter Repositioning

Central Venous Catheterization