• Kaoru Ikejiri, Hiroyuki Goto, Miki Usui, Yuichi Nakayama, Kyoko Sugioka, Asami Ito, Kei Suzuki, Yoshifumi Hirokawa, Keiichi Yamanaka, and Hiroshi Imai.
• Emergency and Critical Care Center, Mie University Hospital, Tsu City, Japan.
• Medicine (Baltimore). 2022 Nov 11; 101 (45): e31755e31755.

RationaleSeptic pulmonary embolism (SPE) and subsequent pneumothorax are rare but serious conditions. We report a case of SPE and pneumothorax caused by central venous port (CV port) infection.Patient ConcernsA 73-year-old woman, who underwent chemoradiotherapy for a head angiosarcoma and a CV port placement, presented with general malaise and myalgia.DiagnosisA laboratory examination showed high levels of inflammatory markers. Chest computed tomography showed fluid collection around the CV port and multiple ground-glass opacities and nodular shadows in the bilateral lung field. She was admitted with a diagnosis of SPE due to CV port infection. The port was removed, and antibiotic administration was initiated; however, she was intubated because of refractory septic shock. Methicillin-susceptible Staphylococcus aureus was detected in the blood and pus around the port site.InterventionsHer respiratory status did not improve despite recovering from septic shock, and radiologic findings showed a left pneumothorax and exacerbation of SPE on day 9. Her condition was judged ineligible for surgery for pneumothorax, and chest tube thoracostomy was continued.OutcomesAir leaks persisted after chest tube thoracostomy, and her respiratory status did not improve despite ventilator management and recruitment maneuvers. Moreover, a right pneumothorax developed on day 19. Her respiratory status gradually worsened, and she died on day 21. Autopsy showed multiple cavitary lesions in the bilateral lungs and emboli containing organization and inflammatory cells that obstructed the pulmonary arterioles.LessonsThis case indicates that CV port-related infections are infrequent and difficult to diagnose; understanding the clinical features of SPE is important because of its high mortality rate; and pneumothorax secondary to SPE is a rare but serious condition and is difficult to treat during ventilator management.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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