Acute Chest Pain Following Parenteral Infusion

A 44-year-old female patient presented to the Chest Pain Unit with acute-onset right chest pain and shortness of breath. She had recently received parenteral nutrition for the first time, via a port system. The port had been implanted 2 days earlier, in line with the Standard Operating Procedure (SOP), due to cancer cachexia caused by pancreatic carcinoma. On X-ray its postinterventional position appeared normal. The point-of-care ultrasound scan showed right-sided pleural effusion with internal echoes. Laboratory analysis of a tissue sample obtained via pleurocentesis, which was bloody and milky in appearance, showed evidence of a transudate. Its glucose level was 799 mg/dL, versus 158 mg/dL in the blood serum. Infusothorax was suspected, so a chest CT was performed. This showed that the tip of the port was located extravasally (arrow). Infusothorax is a complication following central venous catheter insertion. It is usually caused, as in this case, by perforation (arrowhead) of the vena cava (asterisk) followed by infusion into the pleurae. This case was treated by placing a chest drain and then surgically reviewing the port system, which entailed no complications.

Figure

Chest CT

Dr. med. Manuel Rattka, Prof. Dr. med. Wolfgang Rottbauer, PD Dr. med. Sinisa Markovic, Universitätsklinik Ulm, Klinik für Innere Medizin II, [e-mail]

Conflict of interest statement: The authors declare that no conflict of interest exists.

Translated from the original German by Christine Rye.

Cite this as: Rattka M, Rottbauer W, Markovic S: Acute chest pain following parenteral infusion. Dtsch Arztebl Int 2021; 118: 841. DOI: 10.3238/arztebl.m2021.0094