J Dent Anesth Pain Med.  2015 Mar;15(1):31-34.

Acute mediastinitis secondary to delayed vascular injury by a central venous catheter and total parenteral nutrition

• Byeon GJ
• Kim EJ
• Yoon JY
• Yoon SH
• Woo MN
• Kim CH

Abstract

Vascular injury caused by a central venous catheter (CVC) has been reported to be a rare complication, especially delayed vascular injury due to CVC has a few cases and it can be fatal because of delayed recognition and more serious complications. A 59-year-old woman with no available medical history was admitted for treatment of ovarian cancer. For the surgery, a triple-lumen CVC was placed through the left subclavian vein. Parenteral nutrition through the CVC was used for postoperative nutritional management in the first postoperative day. On the sixth postoperative day (POD), the patient suddenly complained of dyspnea. The CT revealed bilateral pleural effusion and irregular soft tissue density and air bubble in anterior mediastinum suggesting migration of the distal portion of the CVC into the anterior mediastium. In the intensive care unit (ICU) bilateral thoracentesis and percutaneous drainage were performed. She was discharged from the ICU in 3 days later and transferred to the general ward. This case emphasizes the possibility of the delayed vascular injury related to CVC and some strategies for prevention of vascular injury.

Keyword

Central venous catheter; Mediastinitis; Total parenteral nutrition; Vascular injury

MeSH Terms

Central Venous Catheters*
Drainage
Dyspnea
Female
Humans
Intensive Care Units
Mediastinitis*
Mediastinum
Middle Aged
Ovarian Neoplasms
Parenteral Nutrition
Parenteral Nutrition, Total*
Patients' Rooms
Pleural Effusion
Subclavian Vein
Thoracentesis
Vascular System Injuries*

Figure

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  Fig. 1 Chest radiograph showing no specific abnormality and the tip of central venous catheter placed in the superior vena cava.

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  Fig. 2 Computed tomography scan shows bilateral pleural effusion with passive atelectasis of adjacent lung parenchyma and irregular soft tissue density and air bubble in anterior mediastinum suggesting mediastinitis. Red line indicates a displacement of the tip of the central venous catheter out of the superior vena cava.

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