Sleeve thrombus fibrosis causing neck pain

Central venous catheter occlusion due to thrombus formation is the most common cause for malfunction of long-term indwelling catheters. The exact pathology and pathogenesis of this common complication is misunderstood because of an array of terms being used interchangeably in the literature. This article identifies the pathogenesis and symptoms and gives suggestions for the treatment of central venous catheter-related thrombosis.

Our case report is of a girl who had a percutaneously placed left subclavian central venous line attached to her vascuport. After 9 months she developed severe pain over the catheter tubing on injection into the port. Surgical exploration of the catheter tubing in the infraclavicular region demonstrated that the pain was due to retrograde flow around the catheter within a sleeve thrombus.

In this type of patient, all precautions should be taken to minimize the risk of thrombus formation, including considering the prophylactic use of anticoagulants.