Central Venous Catheter Induced Septic Thrombosis of the Superior Vena Cava: A Case Report

中心靜脈導管引起之上腔靜脈敗血性血栓－病例報告

張時杰(Shih-Chieh Chang) ； 徐家揚(Chia-Yang Hsu) ； 彭于恩(Yu-En Peng) ； 唐高駿(Gau-Jun Tang)

《重症醫學雜誌》 12卷1期 (2011/03) Pp. 18-23

https://doi.org/10.30035/TCCM.201103.0003

摘要

放置中心靜脈導管所導致的上腔靜脈敗血性血栓是相對地罕見和困難診斷。假使內科治療失敗，其相關的併發症及死亡率就非常的高。在此我們報告一個51歲男性以發燒和持續性的金黃色葡萄球菌敗血症爲其臨床表現。胸部電腦斷層掃瞄顯示上腔靜脈血栓合併敗血性肺栓塞。其治療包含立即移除中心靜脈導管及廣效性抗生素的使用。然而，卻併發三尖瓣感染性心內膜炎、敗血性肺栓塞及急性呼吸衰竭。最後這個病患因敗血性休克及多器官衰竭而死亡。此病例提醒我們針對上腔靜脈敗血性血栓內科治療反應不好的病人應考慮合併外科手術治療。

關鍵字

敗血性血栓 ； 上腔靜脈 ； 金黃色葡萄球菌 ； 肺栓塞

並列摘要

The development of septic thrombosis due to central venous catheterization is relatively rare and difficult to diagnose. The associated morbidity and mortality is high if medical therapy fails. We report a 51-year-old male who presented with fever and persistent Staphylococcus aureus septicemia. The same pathogen was also isolated from the tip of his Hickman catheter. Enhanced computed chest tomography (CT) demonstrated thrombosis of the superior vena cava and septic pulmonary embolization. The treatment included early removal of the infected catheter and intravenous broad-spectrum antibiotics. However, further complications including infective endocarditis of the tricuspid valve, septic pulmonary embolization and acute hypoxic respiratory failure were encountered. The patient ultimately expired due to refractory septic shock and multiple organ failure. This case reminds us that medical therapy may be insufficient and surgical thrombectomy and removal of the infected vein may be necessary.

並列關鍵字

Septic thrombosis ； Superior vena cava ； Staphylococcus aureus ； Pulmonary embolization