Hoarseness: An Unusual Complication of Port-A Catheter Perforation

Abstract

Background: A port-A catheter implantation for cancer patients is popular as a route for chemotherapy. Potential complications exist, such as perforation during chemotherapeutic agent infusion, especially when the port-A tip is incorrectly positioned or when it is in long-term use. Case Report: We report on a patient who presented with hoarseness as a result of port-A catheter perforation-related mediastinitis subsequent to chemotherapeutic agent infusion through the catheter. Conclusions: Hoarseness is a rare complication of port-A perforation and extravasation. To avoid perforation, the tip of the catheter should be located in a high-flow vessel, such as the distal superior vena cava rather than higher in the caval vein, to prevent a locally increased concentration of drugs. We also recommend that a venogram be arranged if extravasation is suspected.

Unilateral vocal fold paralysis as a port complication

“…6 In the case reported by Wang et al the UVFP was caused by a rupture of the subclavian vein with drug extravasation (irinotecan) but normal mobility was recovered within 1 week of drug suspension. 7 In the case reported by Hervé et al the tip of the catheter placed in the subclavian vein migrated to the IJV and resulted in thrombosis and drug extravasation (in this case 5FU) through the vessel, which caused an UVFP that persisted for at least 4 months. 8 Recently, Hamdan and Dabbous 9 described one case of irreversible UVFP secondary to a subclavian vein thrombosis but in this case it was contralateral to the side of the port placement.…”

“…Both these drugs were previously found to be related to UVFP, but in the case of the first one the vocal palsy was transitory and in the second one it persisted but was also associated to IJV thrombosis. 7,8 This patient's skin changes in the area around the port, which led to port removal, could also be justified by drug extravasation. This highlights the importance of using the accurate length of the catheter and guarantee its correct placement.…”