Surgical repair of peripherally inserted central catheter extravasation via a transmanubrial approach

The transmanubrial approach (TMA) offers great exposure for managing complex superior mediastinal pathology while preserving functional anatomy. Here, we report a case of extravascular perforation caused by peripherally inserted central catheter with mediastinal abscess formation, which was successfully treated using a TMA. A 76-year-old woman developed a fever 3 months after the insertion of a peripherally inserted central catheter for parenteral nutrition. Imaging showed catheter tip migration with venous perforation, accompanied by abscess formation in the superior mediastinum. Owing to the anatomical difficulty in accessing this region, TMA was performed to remove the catheter and drain the abscess. The TMA provides optimal access while preserving neck and shoulder mobility, making it a suitable surgical option in older, frail patients.