Implantable Port Developing Septic Pulmonary Emboli and Secondary Spontaneous Pneumothorax

This case report illustrates the rare occurrence of an implantable port becoming infected, forming septic pulmonary emboli (SPE), and eventually a secondary spontaneous pneumothorax (SSP). A 43-year-old male presented to the emergency department for a five-day duration of fevers, generalized malaise, difficulty in breathing, non-productive cough, and left chest pain. Past history revealed right carotid body paraganglioma that required resection, adjuvant chemotherapy via a port in the left subclavian vein, and radiation. The cancer was in remission for one year prior to this admission and the port had not been used in six months, but had not been removed. Chest computed tomography demonstrated bilateral pleural cavitations and parenchymal ground-glass opacities. Blood cultures and subsequent sensitivities grew methicillin sensitive Staphylococcus aureus (MSSA). We initiated empiric broad spectrum coverage and later switched to cefazolin. A left shoulder ultrasound illustrated a subclavian vein thrombus, so the port was removed. Culture of the catheter tip also grew MSSA. Four days later the patient developed acute dyspnea. Repeat imaging showed a new right-sided spontaneous hydropneumothorax with loculated pleural effusions along with progression of the bilateral opacities and cavitations. Therefore, chest tubes were placed with pleural fluid cultures growing MSSA. Additionally, video-assisted thoracoscopic surgery with decortication was performed. The patient was discharged home on six weeks of intravenous cefazolin via a peripherally inserted central catheter (PICC). This case demonstrates that the physicians should be aware of the lethal complications of a port and should attempt to remove them once they are no longer required.