Fibrin sheath-associated endovascular infection of the heart: the Trojan horse of indwelling central venous catheters

Fibrin Sheath Catheter-Related Endovascular Right-Sided Heart Infection in Heart Failure With Reduced Ejection Fraction: A Case Report

Patients with end-stage renal disease (ESRD) receive dialysis through either hemodialysis (HD) or peritoneal dialysis (PD). HD has challenges associated with vascular access and catheter-associated complications. The development of a fibrin sheath is a common complication with tunneled catheters. However, infection of the fibrin sheath is not usually encountered. We discuss the case of a 60-year-old female with ESRD and heart failure with reduced ejection fraction (HFrEF) receiving HD via tunneled right internal jugular (RIJ) Permcath who was diagnosed with an infected fibrin sheath located in the cavoatrial junction via a transesophageal echocardiogram (TEE). Compared to a transthoracic echocardiogram (TTE), a transesophageal echocardiogram provides a much more accurate diagnosis of this rare condition. Treatment primarily involves administering antibiotics based on sensitivity cultures and closely monitoring for any potential complications.

An Uncommon Cause of Recurrent Dialysis Catheter-Related Bacteremia

A 54-year-old man on maintenance hemodialysis with recurrent catheter-related bloodstream infections due to Staphylococcus aureus was admitted. Multiple prior transthoracic echocardiograms failed to reveal any vegetation. Subsequently on transesophageal echocardiography a mass consistent with fibrin sheath vegetations was identified and a follow-up diagnostic computed tomography (CT) venogram confirmed the presence of a fibrin sheath with vegetations.