Long-Term Follow-Up and Clinical Relevance of Incidental Findings of Fibrin Sheath and Thrombosis on Computed Tomography Scans of Cancer Patients with Port Catheters

Thorsten Lichtenstein,1 Kamal Mammadov,2 Karin Rau,1 Nils Große Hokamp,1 Thuy D Do,3 David Maintz,1 De-Hua Chang1,3 1Department of Radiology, University Hospital of Cologne, Cologne, Germany; 2Department of Radiology, Klinikum Aschaffenburg, Aschaffenburg, Germany; 3Department of Diagnostic and Interventional Radiology, University Medical Center Heidelberg, Heidelberg, GermanyCorrespondence: Thorsten LichtensteinInstitut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Köln (AöR), Kerpener Str. 62, Cologne 50937, GermanyTel +49 221 478-82035Email thorsten.lichtenstein@uk-koeln.dePurpose: This retrospective study examined the incidence, progression, and clinical relevance of catheter-related thrombosis (CRT) and/or fibrin sheaths presenting as incidental findings on routine staging computed tomography (CT) scans performed in cancer patients.Patients and Methods: Patients who underwent central venous port catheter (CVC) placement in a tertiary care hospital between September 2010 and August 2013 were followed up for up to five years. Two radiologists assessed the presence of fibrin sheath and thrombosis in consensus in staging CT scan. Patient demographics, type of cancer, preoperative comorbidities, date of CVC placement and CTs, preexisting anticoagulation, as well as the type and treatment of catheter-related complications were determined from the electronic medical record.Results: A total of 194 patients with 530 CT scans and a mean follow-up time of 394 days were included. Fibrin sheaths and thromboses were seen on 46 scans (8.7%) in 30 patients and 80 scans (15.1%) in 35 patients. The incidence of fibrin sheaths and thromboses was found to be 15.5% and 18%, respectively. The comparison to initial CT reports results indicated that fibrin sheaths or thromboses were missed in 106 examinations (20%). Catheter-associated complications were reported in 14 patients (21.5%) without specific therapy.Conclusion: Fibrin sheaths and CRTs are often overlooked on routine CT scans when patients are asymptomatic. The subsequent high complication rate demonstrates the clinical relevance of the initial incidental finding on CT scan. Further studies should elucidate the effect of thrombolytic agents and interventional radiologic treatment in asymptomatic patients.Keywords: catheter-related complications, central venous catheters, port-a-cath, imaging, staging