Life-Threatening Hemoptysis Secondary to a Pulmonary Artery Retained Calcified Fibrin Sheath Embolus Related to a Central Venous Catheter: A Case Report.

A 45-year-old man presented to the emergency department with massive hemoptysis. His medical history included chronic renal failure, ischemic heart failure, and permanent catheter exchange 2 months prior to presentation. CT revealed elongated filling defects in the left lower lobe pulmonary artery, characterized by central low attenuation and peripheral rim-like calcifications, with wedge-shaped consolidation suggestive of pulmonary infarction. The differential diagnosis based on CT findings was a calcified pulmonary embolus or a fractured and embolized perm catheter tip, either of which could have caused the pulmonary infarction. The patient underwent an emergency left lower lobectomy and pulmonary thromboendarterectomy. The pathological diagnosis was a retained fibrin sheath embolism. Although rare, an embolized retained fibrin sheath should be suspected in patients with a central venous catheter when a calcified pulmonary embolus is observed on CT.