Intramedullary Malposition of a Subclavian Port Catheter: A Unique Case Report

Central venous port systems provide reliable long-term venous access for chemotherapy in oncology patients, with generally low complication rates. We report an unprecedented case of a 55-year-old man with metastatic gastric cancer who experienced an intramedullary malposition of a subclavian port catheter. One week post-implantation, a routine computed tomography (CT) scan revealed the catheter track entering the medullary cavity of a thoracic vertebral body. Remarkably, the patient was asymptomatic, and port function was initially preserved. The malpositioned port was removed and a new port was placed correctly without further incident. This represents the first description of an intramedullary catheter malposition, a complication not previously documented in the literature. We discuss the epidemiology of central venous port use, known complications and malposition sites, and the possible pathogenesis of this rare mishap. Emphasis is placed on adherence to current guidelines for port placement including ultrasound guidance and tip confirmation at the cavoatrial junction to prevent malposition. The discussion also outlines management strategies for catheter misplacements and highlights the importance of prompt imaging when malposition is suspected, even in the absence of symptoms. This case underlines that while central venous ports are safe and effective, vigilance for rare complications is warranted. Early identification and correction of malposition can avert potentially serious sequelae and ensure safe chemotherapy delivery.