Pulmonary hypertension due to a retained totally implantable venous access device fragment

Pulmonary hypertension can occur from obstruction of the distal pulmonary arteries by thrombus, ova and parasites, and foreign material. We report a 62-year-old patient who had fatal pulmonary hypertension from an 8-cm fragment of a totally implantable venous access device (TIVAD) retained in the pulmonary artery. Despite long-term therapeutic anticoagulation, pulmonary angiography showed chronic occlusion of the posterior branch of the superior right pulmonary artery with paucity of distal vasculature consistent with an old right upper lobe pulmonary embolus. Retrieval of the fragment was attempted via pulmonary artery catheterization techniques but was unsuccessful. In conclusion, progressive pulmonary hypertension may result from retention of a TIVAD fragment in a central pulmonary artery despite therapeutic anticoagulation. Worsening pulmonary hypertension may have been due to partial obstruction of the main pulmonary arteries, resulting in recurrent thromboembolism or in situ thrombosis, and remodeling of small distal pulmonary arteries.