Central venous access devices related complications: Evaluation with multidetector CT

Background: CVADs play an important role in modern medical patient management and treatment. CVADs are used to administer chemotherapy, for blood draws, hydration, administration of blood products, total parenteral nutrition, or medications, peripheral access, hemodynamic monitoring. Implanting CVADs is performed in the operating room or during interventional radiology. Imaging findings: Before they are used, all CVAD placements should be confirmed by x-ray. For proper placement, the catheter tip should rest in the lower third of the superior vena cava. Right atrium placement can trigger arrhythmias or result in pericardial effusion. Complications associated with the insertion of CVADs include: pneumothorax, cardiac tamponade, arterial rupture, hemorrhage, hemothorax, hydrothorax, air embolus, brachial nerve plexus injury, thoracic duct injury, misplacement, infection. Complications during the use of CVADs are: infection or sepsis, phlebitis, deep vein thrombosis with risk of pulmonary embolism, chemotherapy extravasation, 180° rotation of an implanted port, catheter occlusion, migration or fracture, fibrin sheath formation. We illustrate the spectrum of imaging findings of the main complications associated with CVADs with emphasis on clinical correlation. Conventional x-ray has a limited role in detecting such conditions. Owing to its widespread availability, short examination time, excellent spatial resolution, cost-effectiveness, cross-sectional imaging, panesplorant capability, possibility to obtain multiplanar reformations, MDCT represents the technique of choice to detect CVADs related complications. Conclusion: radiologists must be aware of CVADs related potential complications in order to choose the right imaging technique.