Catheter tip associated inflammatory mass
What is a catheter tip associated inflammatory mass or granuloma, and what is their clinical presentation?
Granulomas are an inflammatory mass that can develop on the catheter tip as a result of intrathecal drug administration. They are most commonly associated with continuous infusion of high concentrations of opioid medications—particularly morphine. The problems created by granuloma formation are twofold: they are highly vascular, resulting in rapid clearance of administered medications, and can form space-occupying lesions within the spinal canal, impinging upon neural structures and resulting in neurologic deficits. Consequently, practitioners should have a high clinical suspicion for granuloma formation if a patient reports diminished efficacy of intrathecal therapy, despite the escalation of therapy and/or if they report new neurologic symptoms and signs.