School ager with a catheter that infuses but does not draw back

Line study of a thrombus on a central venous catheter
Scout image from a line study (above) shows migration of the tip of the catheter 90 degrees so that it now lies flush against the anterior wall of the superior vena cava. AP and lateral views from the line study after contrast injection shows staining of a long thin object resembling thrombus hanging off the tip of the catheter.

The diagnosis was thrombus of the catheter tip and occlusion of the catheter tip due to catheter migration.

Teenager with a catheter that infuses but does not draw back

Line study of a fibrin sheath on a central venous catheter
Image from a line study (above) with the catheter filled with contrast shows a mild dilation in the diameter of the distal catheter, suggesting the contrast is inside a sheath encasing the distal catheter. When contrast is injected through the catheter (below), a sheath is seen to flip off the tip of the catheter to the left.

The diagnosis was fibrin sheath of the catheter tip.

Preschooler with a catheter that is difficult to infuse

Line study of a fibrin sheath on a central venous catheter
CXR obtained 6 months before (above left) compared to the scout image obtained before the line study (above right) shows the tip of the catheter has migrated proximally the height of one vertebral body between the two exams. Image from the line study (below) shows contrast outlining a sheath where the catheter tip used to be.

The diagnosis was fibrin sheath where the tip of the catheter was previously.

Preschooler who is immune suppressed with a fever who had their catheter replaced 9 months ago

CT of an embolized fibrin sheath from a central venous catheter
CXR shows no evidence of pneumonia, but suggests the presence of a tubular structure in the inferior aspect of the left hilum that was not present on a prior CXR obtained before the catheter was replaced. Coronal image from a CT with contrast of the chest better demonstrates the high density tubular structure.

The diagnosis was an embolized fibrin sheath from the prior catheter which was determined by an angiogram.

Infant with catheter that infuses but does not draw back

Line study of central venous catheter with an occluded tip
CXR from 2 weeks earlier (above) shows the tip of the catheter in appropriate position at the junction of the superior vena cava and the right atrium. Scout image from a line study (below) shows the tip of the catheter has migrated backwards in the interval and its tip now rests against the wall of the superior vena cava.

The diagnosis was occlusion of the catheter tip due to catheter migration.

School ager with catheter that infuses but does not draw back

Line study of a central venous catheter tip that has migrated out of the vessel
CXR from 1 month before (above) shows the tip of the catheter in a left-sided superior vena cava. Scout image from a line study (below left) shows the tip of the catheter has apparently migrated out of the left-sided superior vena cava. Injection of the catheter (below right) shows contrast extravasating into the mediastinum.

The diagnosis was migration of the catheter tip out of the vessel into the mediastinum.