Iatrogenic extrapleural hematoma

We encountered a rare case of complications at the time of central venous catheterization due to extrapleural hematoma. A 71-year-old woman was scheduled to undergo subtotal gastrectomy. After introduction of general anesthesia, a CVP catheter was inserted from the right jugular vein, but it was removed intraoperatively, because of poor dropping of the infusion fluid. A few minutes later, the blood pressure started to decrease. We considered that this symptom was derived from the surgical procedure, and rapid blood transfusion associated with administration of a vasopressor was performed. Postoperative chest X ray revealed poorly delineated right lung field, and hemothorax was suspected. However thoracic drainage resulted in an extremely small amount of blood-like fluid. The abnormal defect in the right pulmonary field was found to be an extrapleural hematoma by thoracic CT on the first postoperative day. The hematoma was reduced by subsequent management in 7 days, and the patient was discharged from the ICU without any further complications.