内容紹介
Summary
We report a case of a migrating central venous(CV)catheter with thrombosis in the internal jugular vein that was diagnosed using ultrasonography in a patient complaining of neck pain during chemotherapy. A 57-year-old man with distant metastasis at 1 year after laparoscopic Hartmann operation for rectal cancer was transported to the emergency department by ambulance complaining of severe right-sided neck pain. On that day, his 6th course of chemotherapy with modified FOLFOX6(levofolinic acid, 5-fluorouracil[5-FU], oxaliplatin[L-OHP])and panitumumab was administered using a CV port that had been placed 3 months previously from the right subclavian vein in the superior vena cava, and verified using radiography. Cervical ultrasonography revealed line migration, with a surrounding low echoic area without a Doppler signal in the right internal jugular vein. This migration was also observed on the radiograph. These findings indicated migration of the CV catheter with thrombosis. After admission, the CV catheter was removed, a new one was inserted from the left subclavian vein in the superior vena cava, and a direct oral anticoagulant was administered to treat the thrombosis. Two days later, his neck pain, which was caused by phlebitis that was probably induced by L-OHP or continuous 5-FU, disappeared. We should consider the possibility of CV catheter issues, including migration or damage, when patients experience neck pain during chemotherapy. Additionally, the present case demonstrated the utility of cervical ultrasonography in diagnosing CV catheter migration, as well as thrombosis.
要旨
化学療法中に生じた激しい頸部痛を主訴に救急外来を受診し,頸部エコーにて血栓を合併した内頸静脈への中心静脈(CV)カテーテル迷入と診断された1例を経験した。症例は57歳,男性。直腸癌術後の肝・肺・リンパ節転移,腹膜播種に対して,右鎖骨下静脈経由でのCVポート留置後,modified FOLFOX6[levofolinic acid,5-fluorouracil(5-FU),oxaliplatin(L-OHP)]とpanitumumabの併用療法を導入した。6コース目を開始した深夜に激しい右頸部痛が出現したため,救急外来へ搬送された。頸部エコーにて右内頸静脈内に線状高エコーとその周囲の血栓を認め,胸部X線にて内頸静脈へのCVカテーテル迷入と診断した。頸部痛はL-OHPおよび5-FUによる静脈炎に伴う症状と考えられ,カテーテル抜去後2日目には消失した。また,血栓に対しては直接経口抗凝固薬にて加療を行った。CVポート留置後の合併症として内頸静脈へのカテーテル迷入があり,化学療法後の頸部痛を生じた際には考慮すべきである。また,本症例は造影剤アレルギー歴があり,頸部エコーはカテーテルの迷入に加え血栓の存在診断にも有用であった。
目次
We report a case of a migrating central venous(CV)catheter with thrombosis in the internal jugular vein that was diagnosed using ultrasonography in a patient complaining of neck pain during chemotherapy. A 57-year-old man with distant metastasis at 1 year after laparoscopic Hartmann operation for rectal cancer was transported to the emergency department by ambulance complaining of severe right-sided neck pain. On that day, his 6th course of chemotherapy with modified FOLFOX6(levofolinic acid, 5-fluorouracil[5-FU], oxaliplatin[L-OHP])and panitumumab was administered using a CV port that had been placed 3 months previously from the right subclavian vein in the superior vena cava, and verified using radiography. Cervical ultrasonography revealed line migration, with a surrounding low echoic area without a Doppler signal in the right internal jugular vein. This migration was also observed on the radiograph. These findings indicated migration of the CV catheter with thrombosis. After admission, the CV catheter was removed, a new one was inserted from the left subclavian vein in the superior vena cava, and a direct oral anticoagulant was administered to treat the thrombosis. Two days later, his neck pain, which was caused by phlebitis that was probably induced by L-OHP or continuous 5-FU, disappeared. We should consider the possibility of CV catheter issues, including migration or damage, when patients experience neck pain during chemotherapy. Additionally, the present case demonstrated the utility of cervical ultrasonography in diagnosing CV catheter migration, as well as thrombosis.
要旨
化学療法中に生じた激しい頸部痛を主訴に救急外来を受診し,頸部エコーにて血栓を合併した内頸静脈への中心静脈(CV)カテーテル迷入と診断された1例を経験した。症例は57歳,男性。直腸癌術後の肝・肺・リンパ節転移,腹膜播種に対して,右鎖骨下静脈経由でのCVポート留置後,modified FOLFOX6[levofolinic acid,5-fluorouracil(5-FU),oxaliplatin(L-OHP)]とpanitumumabの併用療法を導入した。6コース目を開始した深夜に激しい右頸部痛が出現したため,救急外来へ搬送された。頸部エコーにて右内頸静脈内に線状高エコーとその周囲の血栓を認め,胸部X線にて内頸静脈へのCVカテーテル迷入と診断した。頸部痛はL-OHPおよび5-FUによる静脈炎に伴う症状と考えられ,カテーテル抜去後2日目には消失した。また,血栓に対しては直接経口抗凝固薬にて加療を行った。CVポート留置後の合併症として内頸静脈へのカテーテル迷入があり,化学療法後の頸部痛を生じた際には考慮すべきである。また,本症例は造影剤アレルギー歴があり,頸部エコーはカテーテルの迷入に加え血栓の存在診断にも有用であった。