Rare case of SVC perforation secondary to PICC line

Background

While relatively rare, complications from peripherally inserted central catheter (PICC) lines can carry serious morbidity and mortality. PICC lines are known to be associated with infection and thromboembolism, though literature discussing vessel perforation from PICC lines is limited, and to our knowledge there are no reports describing specifically the superior vena cava (SVC) being perforated from a PICC line.

Case report

In this report, we describe a case of a 48-year-old female who presented with chest pain in the setting of having a PICC line for chronic medical conditions. A computed tomography with angiography (CTA) was obtained and revealed perforation of the SVC and subsequent mediastinitis from her PICC line. Her PICC line was immediately secured, broad spectrum antibiotics were given, and cardiothoracic surgery was consulted. She subsequently had her PICC removed under ultrasound guidance with plans for immediate operative intervention if that failed. The patient did well and was ultimately discharged with a new PICC line.

Why should an emergency physician be aware of this?

Although large vessel perforation from PICC lines is relatively rare, it can be associated with significant morbidity and needs immediate treatment. It is important for the emergency physician to have knowledge of this complication to make the diagnosis and initiate timely specialist intervention.