Port-a-Cath Fragmentation Causing Recurrent Chest Pressure and Dizziness in an Elderly Man: A Case Report

Background: A port-a-catheter is a long-term vascular access device designed for patients requiring prolonged access to a large venous vessel. These devices are typically surgically inserted into the internal jugular vein, subclavian vein, or superior vena cava. Case: A 71-year-old male with a history of follicular lymphoma in remission following treatment with six cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) presented with a 10-week history of intermittent chest pressure and dizziness. During a routine follow-up visit with his oncologist, a screening computed tomography (CT) scan revealed a fragmented port-a-catheter. The catheter fragment was coiled within the right and left main pulmonary arteries. The patient underwent fluoroscopic-guided retrieval of the fragment, resulting in complete resolution of his symptoms. Conclusion: Fractured port-a-catheters can migrate to the pulmonary arteries, leading to increased pulmonary pressure and irritation of the pulmonary endothelium. This can manifest as chest discomfort, chest pressure, dizziness, and episodic hypertensive emergencies. Prompt recognition, confirmation with imaging, and retrieval of the fractured catheter are crucial to prevent serious complications. Physicians should consider catheter fragmentation and migration as possible causes when diagnosing patients with similar symptoms who have a known indwelling port.