Right atrial catheter “ghost” removal by cardiac surgery: A pediatric case series report

Abstract

Fibrin sheath formation around long-term indwelling central venous catheters is common and usually benign. Fibrin sheath can persist after catheter removal and rarely leads to complications. This is a report of three pediatric oncology patients that required cardiac surgery for cardiac embolization of a "ghost" catheter several years after catheter removal. One case required tricuspid valve replacement for complete tricuspid valve destruction and two had erosion through the atrial wall. The severity of these rare complications mandates follow-up of "ghost" catheters in pediatric oncology patients. K E Y W O R D Scardiology, pediatric hematology/oncology, surgery

The fibroblastic sleeve, the neglected complication of venous access devices: A narrative review

“…11 However rarely, a persisting FS may undergo calcification: a calcified FS was detected 7 years after catheter removal. 77 In a retrospective study on 147 patients who had recently removed a central VAD, Krausz et al 20 visualized the persistent FS at CT scan in 20 cases (13.6%); in 9 of the 20 cases, the sleeve was apparently calcified.…”

“…A persistent FS might also be an accidental finding during TEE, 18 appearing as a thin and long hyper-echogenic image floating in the superior vena cava. In some rare occasions, the persistent FS might be very thick and dense, and even calcified, and mistakenly interpreted as a retained catheter fragment at chest X-ray, CT scan, trans-thoracic echocardiography (TTE), 26,77 or TEE. 17,44,45,[78][79][80] Of course, the sleeve around the catheter will persist also in its extravascular tract (Figures 6).…”

“…78,79,81 The differential diagnosis between FS and catheter fragment may require echocardiography 18,83 or even CT scan. 37,78 There have been rare reports of removal of residual FS, 26,77 though the actual usefulness of this maneuver is questionable.…”

A Rare Case of Successfully Treated Double Valve Infective Endocarditis Caused by Pseudomonas aeruginosa

“…Fibrin sheath formation around an indwelling central venous catheter is common and usually uncomplicated. The persistence of the fibrin sheath after catheter removal, also known as a “ghost” catheter fibrin sleeve (GCFS), occurs in only 15% of patients and is usually an incidental finding [ 1 , 2 , 3 ].…”

“…Pseudomonas aeruginosa is a rare infective endocarditis (IE) pathogen, accounting for approximately 3% of all cases [ 2 ]. The majority of reports indicate that P. aeruginosa IE is more aggressive and has a higher mortality rate [ 4 ].…”