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Microscopic pulmonary embolisation of an indwelling central venous catheter with granulomatous inflammatory response

Depts of ¹ Internal Medicine, and ² Dept of Pathology, Division of Pulmonary and Critical Care Medicine, Keck School of Medicine, University of Southern California, Los Angeles, and ³ Dept of Pathology, and ⁴ Division of Pulmonary and Critical Care Medicine, Simi Valley Hospital, Simi Valley, CA, and ⁵ Dept of Environmental and Infectious Disease Science, Division of Biophysical Toxicology, Armed Forces Institute of Pathology, Washington, DC, USA.

CORRESPONDENCE: A. Baydur, Professor of Medicine, Division of Pulmonary and Critical Care Medicine, Keck School of Medicine, 2025 Zonal Avenue, GNH 11-900, Los Angeles, CA, USA. Fax: 1 3232262738. E-mail: baydur@usc.edu

Keywords: Bisphenol-A-polycarbonate, catheter embolisation, catheter fragmentation, foreign-body granulomas

Received: November 23, 2004
Accepted March 8, 2005

Indwelling catheters can disintegrate into tiny fragments and embolise. Once the fragments are detected radiographically, they can be removed using vascular intervention techniques. Rarely, indwelling catheters dwindle into inextricable pieces that embolise into minute pulmonary vessels and lymphatics, causing granulomatous changes microscopically.

The present study reports a 54-yr-old female who had received several indwelling central lines during several abdominal surgeries over a 5-yr period. The patient developed a noncaseating granulomatous skin lesion followed by exertional dyspnoea a few months later. Chest radiographs and computed tomography showed diffuse interstitial infiltrates. Open lung biopsy showed two types of granulomas: 1) peri-lymphangitic and peri-bronchiolar non-necrotising granulomas consistent with sarcoidosis; and 2) distinct foreign body granulomas.

In some of the foreign body granulomas, confocal Raman spectroscopy identified the presence of bisphenol-A-polycarbonate, a polymer commonly used in biomedical devices. The patient improved following treatment with prednisone followed by methotrexate.

The present case illustrates an interesting combination of two causes of granulomatous disease, the importance of examining all biopsy specimens from sarcoidosis patients for foreign particles and the rare occurrence of microscopic embolisation of catheter fragments to the lung with foreign-body giant cell reaction to them.