Portkatheter-assoziierte obere Einflussstauung bei einem Patienten mit Rektumkarzinom

Zusammenfassung

Anamnese und klinischer Befund | Ein ansonsten beschwerdefreier 59-jähriger Patient mit metastasiertem Rektumkarzinom entwickelt plötzlich eine ausgeprägte Zyanose im Bereich des Gesichts, die sich über Hals und beide Arme ausbreitet. Während der vergangenen Monate war er über einen Port-Katheter mit Folinsäure, 5-Fluorouracil, Irinotecan und Aflibercept behandelt worden. Abgesehen von Zigarettenkonsum ist die weitere Anamnese unauffällig.

Untersuchungen | In der Computertomografie zeigt sich eine Port-Katheter-assoziierte Thrombose mit konsekutiver oberer Einflussstauung. Eine Lungenarterienembolie und ein thorakales Aortenaneurysma können ausgeschlossen werden.

Therapie und Verlauf | Wir leiten umgehend eine therapeutische Antikoagulation ein. Aufgrund eines kurzen Bewusstseinsverlustes verabreichen wir zudem Glukokortikoide und Katecholamine. Da die Zyanose auch während der nächsten Tage anhält, führen wir eine transfemorale Angioplastie mit Stent-Implantation in die V. cava superior durch. Die Zyanose bildet sich vollständig zurück und der Patient kann entlassen werden.

Folgerungen | Obere Einflussstauungen aufgrund einer Port-Katheter-assoziierten Thrombose bei Tumorpatienten sind selten. Es ist zu erwarten, dass Port-Katheter-assoziierte thrombembolische Komplikationen zunehmen, da die Anzahl der Tumorpatienten, intravenösen Kathetersysteme und Schrittmachersonden steigt. Die frühzeitige Computertomografie mit Kontrastmittel über einen Femoralis-Katheter ist für die Diagnostik und Therapie sinnvoll. Bei Tumorpatienten ist die endovaskuläre Stentimplantation eine sichere und effektive Therapieoption.

Abstract

History and clinical findings | A 59-year-old man with metastasized rectum cancer presents at the interdisciplinary emergency care unit with a distinct cyanosis of his face. At that moment the patient himself is out of any complaints. Cyanosis is spreading from his face over his neck to both arms. During the last months he has been treated with folinic acid, 5-fluoruracil, irinotecan and aflibercept via a port-catheter. Except for smoking his further medical history is unremarkable.

Examinations | CT-scan shows a port-catheter associated thrombosis with a consecutive superior vena cava syndrome (SCVS). No signs of an acute pulmonary embolism or thoracic aortic aneurysm are detected.

Treatment and course | Anticoagulation is started immediately. Due to a short loss of consciousness glucocorticoids and vasopressors are given. As cyanosis continued during next days, a transfemoral percutaneous angioplasty with stent placement was performed. Cyanosis disappears completely and the patient can be discharged.

Conclusions | SCVS due to port-catheter associated thrombosis in tumor patients is rare but its prevalence will grow because of increasing numbers of tumor patients, intravenous catheter-systems and pacemakers. Early CT-scan with contrast agent via femoral venous catheter is reasonable for diagnosis and therapy. For tumor percutaneous transluminal angioplasty is a safe and effective option.

Schlüsselwörter

obere Einflussstauung - Port-Katheter - Thrombose - Tumor - Stent - Aflibercept

Keywords

superior vena cava syndrome - port-catheter - thrombosis - tumor - stent - aflibercept

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