C52-47 The Phantom Catheter - Calcified Catheter Cast Mimicking Retained Foreign Body

Abstract Introduction A retained foreign catheter tip following removal of a midline and peripherally inserted central catheter (PICC) is a rare but serious event with potential complications including thrombophlebitis, catheter-related blood stream infection, and embolism. Immediate surgical removal of such foreign bodies is often indicated which itself carries risk making correct and timely identification paramount. This can be challenging due to calcified catheter casts which mimic catheter tips and are often indistinguishable on imaging. The management of calcified catheter casts is not well studied and requires further investigation. This reports aims to present a case report of a calcified catheter cast to provide further insight into diagnostics, clinical course, and management. Description A 79-year-old male with a past medical history notable for deep vein thromboses and squamous cell carcinoma was hospitalized for septic shock secondary to necrotizing fasciitis of the foot. His hospital course was prolonged and complicated. Two months into his admission, he was noted to have left upper extremity (LUE) swelling concerning for deep vein thrombosis (DVT). A subsequent LUE ultrasound revealed a tubular density in the upper basilic vein which resembled a catheter. The patient had no history of midline or PICC placement in that arm and it was believed this may represent the tip of a broken peripheral IV that had migrated proximally to its current location. Vascular surgery was consulted, finding this represented a calcified catheter cast from a peripheral IV and that no surgical intervention was needed. The patient continued his baseline anticoagulation thromboembolism prophylaxis and his LUE swelling resolved over the next one to two days. It was believed the initial cause of his swelling was unrelated to the cast. Discussion This case highlights the importance of correctly identifying catheter casts on imaging to avoid unnecessary surgical interventions. Although removal of peripheral catheter tips are known to be relatively low risk procedures, interventions for centrally located tips carry increased risks. The diagnosis of calcified catheter cast need be considered whenever a retained catheter tip is identified on imaging. Some studies suggest the incidence of calcified fibrin sheaths following catheter tip removal to be as high as 6.12%. The risk of calcified catheter casts themselves is not well studied or reported and while less dangerous than retained catheter tips, are not without complication. Further research need be pursued to determine what management is necessary when calcified casts are identified. This abstract is funded by: None