Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 16, 2022; 10(17): 5776-5782
Published online Jun 16, 2022. doi: 10.12998/wjcc.v10.i17.5776
Massive hemothorax following internal jugular vein catheterization under ultrasound guidance: A case report
Hyun Kang, Soo Young Cho, Eun Ha Suk, Wan Ju, Joon Yong Choi
Hyun Kang, Soo Young Cho, Eun Ha Suk, Wan Ju, Joon Yong Choi, Department of Anesthesiology and Pain Medicine, Kwangju Christian Hospital, Gwangju 61661, South Korea
Author contributions: Kang H and Choi JY cared for the patient, conceived, and designed the case report, and wrote the manuscript; Wan JU, Cho SY and Suk EH edited the manuscript; Cho SY and Suk EH supervised the work; all authors read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Soo Young Cho, MD, PhD, Professor, Anesthesiology and Pain Medicine, Kwangju Christian Hospital, Kwangju Christian Hospital, 37 Yangnim-ro, Nam-gu, Gwangju 61661, South Korea. tndud2584@gmail.com
Received: November 11, 2021
Peer-review started: November 11, 2021
First decision: December 10, 2021
Revised: December 22, 2021
Accepted: April 4, 2022
Article in press: April 4, 2022
Published online: June 16, 2022
Processing time: 210 Days and 0.9 Hours
Abstract
BACKGROUND

Hemothorax is a rare but life-threatening complication of central venous catheterization. Recent reports suggest that ultrasound guidance may reduce complications however, it does not guarantee safety

CASE SUMMARY

A 75-year-old male patient was admitted for laparoscopic radical nephrectomy. Under ultrasound guidance, right internal jugular vein catheterization was successfully achieved after failure to aspirate blood from the catheter in the first attempt. Sudden hypotension developed after surgical positioning and persisted until the end of the operation, lasting for about 4 h. In the recovery room, a massive hemothorax was identified on chest radiography and computed tomography. The patient recovered following chest tube drainage of 1.6 L blood.

CONCLUSION

Hemothorax must be suspected when unexplained hemodynamic instability develops after central venous catheterization despite ultrasound guidance. So the proper use of ultrasound is important

Keywords: Central venous catheterization; Hemothorax; Ultrasound guidance; Internal jugular vein; Case report

Core Tip: During central venous catheterization via internal jugular vein, physicians should be aware of the possibility of hemothorax, even during ultrasound-guided procedures due to difficulty achieving real-time visualization of the dilator or catheter tip into the thorax. Confirmation of the guidewire within the brachiocephalic vein is recommended to prevent guidewire malposition, one of the reasons for dilator-induced hemothorax. In hemothorax caused by intrathoracic venous injury, the development of hemodynamic compromise can be delayed and managed with supportive care, obscuring prompt diagnosis during anesthesia. Clinical suspicion and timely diagnostic evaluations are needed for early diagnosis and treatment.