Totally implantable venous access device (TIVAD) migration into the pleural space: A case report

Introduction

Totally implantable venous access devices (TIVADs) offer significant advantages for long-term intravenous therapy, but their use is not without potential complications. Catheter migration is one of them.

Case presentation

An 11-year-old boy with a primitive neuro-ectodermal tumor (PNET) undergoing chemotherapy was a candidate for a TIVAD placement. A TIVAD was implanted through the right internal jugular vein and secured to the pectoralis major in a right thoracic subcutaneous pouch without complications. Approximately six months later, port malfunction was noticed. Physical examination revealed that the port was no longer palpable, and a chest X-ray confirmed that the port was displaced. Subsequent chest X-rays showed different locations of the port and the catheter. With the hypothesis that the port had entered the pleural space and was moving freely, we did an exploratory thoracoscopy. We confirmed the intrapleural position of the port and catheter and removed both without complications. The patient was discharged four days later.

Conclusion

Although rare, TIVADs can migrate from the chest wall into the pleural cavity. Frequent evaluation of their function and position is critical for the early detection of complications.