Improved detection of an intravascular catheter using dual energy subtraction radiography

A 68 year old woman was admitted for discitis and required subsequent antimicrobial therapy, necessitating placement of a 35 cm right-sided peripherally-inserted central catheter into the superior vena cava under ultrasound and fluoroscopic guidance. Eleven months after intial placement of the catheter, the patient was admitted for pneumonia. At that time, a posteroanterior dual energy chest radiograph was performed, which revealed the interval embolization of a catheter fragment into the right side of the heart. The bone-optimized dual-energy image shows the fragment with the distal tip located in the right ventricular outflow tact (Figure 1). Compared to the standard single-energy posteroanterior radiograph (Figure 2), delineation of the embolized catheter was clearly superior on the dual energy subtracted image. This detection allowed for subsequent intravascular catheter fragment retreival under fluoroscopic guidance and improvement in the patient’s clinical outcome. Figure 1Bone-optimized dual-energy image delineation shows more clearly the embolized catheter when compared to the standard radiograph.