Life-Threatening Hemoptysis Secondary to a Pulmonary Artery Retained Calcified Fibrin Sheath Embolus Related to a Central Venous Catheter: A Case Report

Figures

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  Fig. 1. Embolized retained fibrin sheath in the left lower pulmonary artery. A, B. Axial (A) and coronal (B) CT images in the mediastinal window showing a filling defect (arrowhead in A) with tube-like calcification (arrows in B) in the left lower lobe pulmonary artery. The proximal end of the tube-like calcification is smaller in diameter than the distal end, suggesting an embolized retained fibrin sheath rather than a fractured venous catheter tip. C. Axial CT image in the lung setting demonstrating subpleural consolidation and ground-glass attenuation with internal air pockets in the left lower lobe (arrowheads), suggesting pulmonary infarction.

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  Fig. 2. Retained fibrin sheath (arrows) around a central venous catheter at the right brachiocephalic vein on CT images performed 1.5 months earlier. Linear calcification around the central venous catheter is noted at the right brachiocephalic vein, suggesting a calcified fibrin sheath or retained fibrin sheath on the coronal image.

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  Fig. 3. Pathologic specimen and microscopic findings suggesting embolized calcified fibrin sheath in the pulmonary artery. A. Pulmonary hemorrhagic infarction (arrow) is observed at the left lower lobectomy specimen. B. Embolus within the pulmonary artery (arrows) is shown on H&E stain (×10). C. Calcification (violet color) and fibrin (arrow) are observed in the embolus on H&E stain (×100). H&E = hematoxylin & eosin