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Emergent Median Sternotomy for Mediastinal Hematoma: A Rare Complication following Internal Jugular Vein Catheterization for Chemoport Insertion-A Case Report and Review of Relevant Literature.

Biswas S, Sidani M, Abrol S - Case Rep Anesthesiol (2014)

Bottom Line: Injury to the central venous system is the result of either penetrating trauma or iatrogenic causes as in our case.Meticulous surgical technique, knowledge of the possible complications, and close monitoring in the postprocedural period are of utmost importance.Chest X-ray showed to be routinely done to detect any complication early.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Brookdale University Hospital Medical Center, Brooklyn, NY 11212, USA.

ABSTRACT
Mediastinal hematoma is a rare complication following insertion of a central venous catheter with only few cases reported in the English literature. We report a case of a 71-year-old female who was admitted for elective chemoport placement. USG guided right internal jugular access was attempted using the Seldinger technique. Resistance was met while threading the guidewire. USG showed a chronic clot burden in the RIJ. A microvascular access was established under fluoroscopic guidance. Rest of the procedure was completed without any further issues. Following extubation, the patient complained of right-sided chest pain radiating to the back. Chest X-ray revealed a contained white out in the right upper lung field. She became hemodynamically unstable. Repeated X-ray showed progression of the hematoma. Median Sternotomy showed posterior mediastinal hematoma tracking into right pleural cavity. Active bleeding from the puncture site at RIJ-SCL junction was repaired. Patient had an uneventful recovery. Injury to the central venous system is the result of either penetrating trauma or iatrogenic causes as in our case. A possible explanation of our complication may be attributed to the forced manipulation of the dilator or guidewire against resistance. Clavicle and sternum offer bony protection to the underlying vital venous structures and injuries often need sternotomy with or without neck extension. Division of the clavicle and disarticulation of the sternoclavicular joint may be required for optimum exposure. Meticulous surgical technique, knowledge of the possible complications, and close monitoring in the postprocedural period are of utmost importance. Chest X-ray showed to be routinely done to detect any complication early.

No MeSH data available.


Related in: MedlinePlus

Postprocedural chest X-ray showing right mediastinal hematoma. Thoracic and vascular surgery team was consulted immediately and the decision was made to emergently take the patient to the operating room for evacuation of a mediastinal hematoma. Central and arterial access was obtained and transfusion of packed red blood cells (PRBC) was started. The hemodynamic status improved.
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fig3: Postprocedural chest X-ray showing right mediastinal hematoma. Thoracic and vascular surgery team was consulted immediately and the decision was made to emergently take the patient to the operating room for evacuation of a mediastinal hematoma. Central and arterial access was obtained and transfusion of packed red blood cells (PRBC) was started. The hemodynamic status improved.

Mentions: Soon after, the patient decompensated with the systolic blood pressure dropping to 60 mm Hg. Volume resuscitation with crystalloids was started and the patient was cross-matched for transfusion of blood products. A third CXR was obtained during this time revealing the progression of a hemothorax in the right side of the chest (Figure 3).


Emergent Median Sternotomy for Mediastinal Hematoma: A Rare Complication following Internal Jugular Vein Catheterization for Chemoport Insertion-A Case Report and Review of Relevant Literature.

Biswas S, Sidani M, Abrol S - Case Rep Anesthesiol (2014)

Postprocedural chest X-ray showing right mediastinal hematoma. Thoracic and vascular surgery team was consulted immediately and the decision was made to emergently take the patient to the operating room for evacuation of a mediastinal hematoma. Central and arterial access was obtained and transfusion of packed red blood cells (PRBC) was started. The hemodynamic status improved.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3926366&req=5

fig3: Postprocedural chest X-ray showing right mediastinal hematoma. Thoracic and vascular surgery team was consulted immediately and the decision was made to emergently take the patient to the operating room for evacuation of a mediastinal hematoma. Central and arterial access was obtained and transfusion of packed red blood cells (PRBC) was started. The hemodynamic status improved.
Mentions: Soon after, the patient decompensated with the systolic blood pressure dropping to 60 mm Hg. Volume resuscitation with crystalloids was started and the patient was cross-matched for transfusion of blood products. A third CXR was obtained during this time revealing the progression of a hemothorax in the right side of the chest (Figure 3).

Bottom Line: Injury to the central venous system is the result of either penetrating trauma or iatrogenic causes as in our case.Meticulous surgical technique, knowledge of the possible complications, and close monitoring in the postprocedural period are of utmost importance.Chest X-ray showed to be routinely done to detect any complication early.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Brookdale University Hospital Medical Center, Brooklyn, NY 11212, USA.

ABSTRACT
Mediastinal hematoma is a rare complication following insertion of a central venous catheter with only few cases reported in the English literature. We report a case of a 71-year-old female who was admitted for elective chemoport placement. USG guided right internal jugular access was attempted using the Seldinger technique. Resistance was met while threading the guidewire. USG showed a chronic clot burden in the RIJ. A microvascular access was established under fluoroscopic guidance. Rest of the procedure was completed without any further issues. Following extubation, the patient complained of right-sided chest pain radiating to the back. Chest X-ray revealed a contained white out in the right upper lung field. She became hemodynamically unstable. Repeated X-ray showed progression of the hematoma. Median Sternotomy showed posterior mediastinal hematoma tracking into right pleural cavity. Active bleeding from the puncture site at RIJ-SCL junction was repaired. Patient had an uneventful recovery. Injury to the central venous system is the result of either penetrating trauma or iatrogenic causes as in our case. A possible explanation of our complication may be attributed to the forced manipulation of the dilator or guidewire against resistance. Clavicle and sternum offer bony protection to the underlying vital venous structures and injuries often need sternotomy with or without neck extension. Division of the clavicle and disarticulation of the sternoclavicular joint may be required for optimum exposure. Meticulous surgical technique, knowledge of the possible complications, and close monitoring in the postprocedural period are of utmost importance. Chest X-ray showed to be routinely done to detect any complication early.

No MeSH data available.


Related in: MedlinePlus