Late development of hydrothorax induced by a central venous catheter: Report of a case

We report herein the case of a 47-year-old woman who suffered a hydrothorax induced by a central venous catheter (CVC) which had been placed to facilitate total parenteral nutrition following a left sleeve pneumonectomy for lung cancer. The CVC was inserted into the superior vena cava (SVC) through the left subclavian vein after the operation; however, the tip inadvertently turned upward and came in contact with the lateral wall of the SVC. The patient suddenly developed dyspnea due to a right-sided hydrothorax 47 days after the insertion of the catheter. Indocyamine green administered through the catheter was thereafter found in the pleural fluid. The continuous mechanical force of the catheter tip against the SVC wall was thus considered to be the cause of this life-threatening delayed hydrothorax.     

Delayed pneumothorax and hydrothorax with central venous catheter migration

We report a case of delayed pneumothorax, central venous catheter migration and iatrogenic hydrothorax in a 22-year-old female. The left subclavian central venous catheter initially transfixed the lung apex; pneumothorax occurred 24 h later following initiation of positive pressure ventilation. Lung collapse as a result of the pneumothorax caused catheter migration and hydrothorax. Catheter removal and chest drainage led to an uneventful recovery.     

Tension hydrothorax induced by central venous catheter migration in a patient with burns

Editor—We describe an unusual complication of tensionhydrothorax, induced by migration of a central venous catheterin an ICU patient with burns. Correct clinical diagnosis resultedin an immediate intervention and insertion of pleural drainage. A 48-yr-old male was referred to our hospital with deep, thirddegree 30% total body surface area flame burns. He had attemptedsuicide by self-immolation. He was transferred to burn ICU.According to standard protocol, his trachea was intubated becauseof suspected     

Bilateral hydrothorax complicating central venous catheterization in a child: case report

It is necessary to consider catheter-related events when a previously stable patient has an acute change in cardiopulmonary status, regardless of the duration of catheter use; and to recognize that hydrothorax from vein perforation may be bilateral, necessitating bilateral drainage procedures.     

Late mediastinitis with bilateral hydrothorax after vessel perforation by a central venous catheter

A central venous catheter was inserted into the right internal jugular vein of a 67-year-old woman to provide parenteral nutrition on the 7th day after surgery. Five days later, mediastinitis with bilateral hydrothorax had developed and was causing respiratory failure and systemic inflammatory response syndrome secondary to documented vascular perforation by the catheter. Four factors have been associated with increased risk of perforation: catheter rigidity and diameter, the angle between the tip of the catheter and the vessel wall, and insertion from the left. Three catheter positions have been described as safe when radiologically confirmed: the superior vena cava, the point where the superior vena cava meets the atrium, and the midpoint of the innominate vein. However, it should not be forgotten that a radiograph is 2-dimensional and a single image of a catheter tip can correspond to a variety of locations (superior vena cava, vena innominata, extravascular location, and more). Even when there is clinical and radiologic evidence of catheter positioning, vascular perforation should be suspected in patients with a central venous catheter and bilateral pleural effusion who present respiratory insufficiency and hemodynamic instability.     

Secondary migration of a central venous catheter. A case report

A case of central venous catheter (CVC) secondary migration in a patient with Hodgkin's lymphoma is reported. The catheter was inserted in the right internal jugular vein with anterior approach. The correct position of the catheter tip in the superior vena cava was confirmed by X-ray. Secondary migration to the right subclavian vein, without displacement at the point of insertion, was reported 8 days later by a chest X-ray performed for worsening of the respiratory condition. CVC was removed and reinserted with the same procedure. The correct position of the catheter tip was confirmed by thoracic radiography till 10 days later. Epidemiological data present in the literature and secondary migration predisposing factors are reported.     

Malposition of central venous catheter in the left internal jugular vein--a case report

Malposition of central venous catheter is a complication of central venous catheterization. A case of left internal jugular catheterization via left external jugular vein is reported. Details of the procedure are described and the literature is reviewed for similar malpositions.     

Mediastinal infusion by a multilumen central venous catheter

A case of mediastinal perfusion by a left internal jugular vein catheter is reported. The catheter was of Shaldon type with six lateral side-holes. The patient displayed progressive pulmonary oedema and peripheral vasoconstriction, whereas clinically the catheter seemed to work quite well. Only radiological control with injection of radiopaque dye demonstrated mediastinal penetration of the catheter tip including the most distal side-hole. The five more proximally located holes remained in intravascular position. The authors advocate radiographic catheter control with radiopaque dye in every catheterized patient demonstrating cardiorespiratory manifestations of unknown origin.     

Formation of a calcified "cast" in a long-term indwelling central venous catheter: a case report

Catheter-related central venous thrombosis is a complication seen with long-term indwelling central venous catheters. The uses of total parenteral nutrition, catheter location, and duration of catheter use have been shown to increase the risk of thrombus formation. However, organized calcification of such a thrombus is a rare occurrence and, to our knowledge, has never been reported in a patient unexposed to total parenteral nutrition. We report a patient with an extensive, organized, calcified “cast” surrounding a central venous catheter used solely for chemotherapy administration.     

Delayed subarachnoid migration of an epidural catheter: a case report

We often experience migration of an epidural catheter into an undesirable space. Migration of an epidural catheter into the subarachnoid space is a potentially lethal complication. Although almost all migrations of epidural catheters have been reported to occur at insertion of the catheter, we experienced a case of catheter migration into the subarachnoid space two days after its insertion. The symptoms caused by this migration were motor paralysis in the lower extremities and sensory disturbance of the trunk. Neurological and hemodynamic changes in a patient who is undergoing continuous epidural infusion of local anesthetics should be monitored carefully.     

The residual central venous catheter track--an occult source of lethal air embolism: case report

Air embolization through a residual track after removal of a central venous catheter is an elusive mechanism of a treacherous problem. Prompt diagnosis is necessary for successful application of established therapy, as demonstrated by this case report. Awareness of this unusual mechanism of air embolism with utilization of simple prophylactic measures, however, remains the best treatment.