Computed Tomographic Appearance of Chest Ports and Catheters: A Pictorial Review for Noninterventional Radiologists

Medical practice has expanded the need for long-term central venous catheterization. Chest ports play an important role in the management of oncology patients who need frequent blood products, chemotherapy, and other intravenous drugs. Imaging-guided placement of chest ports and catheters (CR) is a safe and efficacious procedure. Moreover, many cases of catheter-induced central thrombosis go unrecognized, but the incidence of pulmonary embolism in this group may be as high as 12%. Multi-detector computed tomography represents the main imaging method in the follow-up of oncologic patients. We review the radiologic features, mainly on multi-detector computed tomography, of CR commonly used for chemotherapy administration and describe the radiological findings of the complications associated with these devices. Examples of complications include the following: pneumothorax, inversion of the reservoir and malpositioned catheter, great vessel perforation, fibrin sheath formation and catheter-related venous thrombosis, infection, Pinch-off syndrome, and extravasation. When interpreting computed tomography (CT) in oncologic patients, radiologists should be familiar with CR and comment on catheter's position, and the presence or absence of complications. General radiologists should keep in mind the medical history of the patient with regards to the CR and the specific CT findings when they read radiological studies in oncologic patients. Appropriate window values and multi-plane CT reconstructions are useful in the diagnosis of CR-related complications.