Calcified Catheter-Related Fibrin Sheath Forms Large Intravenous Cast in Hemodialysis Patient Causing Embolic Sequelae

Catheter-related sheath (CRS) formation secondary to chronic indwelling central venous catheters (CVC) is a well-documented complication. When these fibrin sheaths calcify, they can form a “cast” surrounding the catheter. Upon removal of the CVC, a rare complication can occur where the calcified sheath remains in situ leaving behind an intraluminal catheter-shaped cast. This report describes a case of a 57-year-old dialysis-dependent woman who was found to have a right internal jugular vein cast during the evaluation and treatment of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. This case reviews and discusses the embolic complications suspected to be a result of this cast. Our case provides insight into the clinical course, diagnostic methods, and imaging identification of a rare pathology and its unique complications.