Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 16, 2023; 11(29): 7207-7213
Published online Oct 16, 2023. doi: 10.12998/wjcc.v11.i29.7207
Emphysematous thrombophlebitis caused by a misplaced central venous catheter: A case report
Ni Chen, Hua-Jun Chen, Tao Chen, Wen Zhang, Xiao-Yun Fu, Zhou-Xiong Xing
Ni Chen, Hua-Jun Chen, Tao Chen, Wen Zhang, Xiao-Yun Fu, Zhou-Xiong Xing, Department of Critical Care Medicine, The Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
Zhou-Xiong Xing, Department of Critical Care Medicine, Kweichow Moutai Hospital, Renhuai 564500, Guizhou Province, China
Author contributions: Chen N reviewed the literature, and contributed to manuscript drafting; Chen HJ and Zhang W summarized the clinical features and drafted the manuscript; Chen T and Fu XY helped draft the manuscript and review the literature; Xing ZX helped review the literature, performed the bedside ultrasound and made important contributions to the manuscript; all authors have approved the final version of the manuscript.
Supported by Foundation of Guizhou Science and Technology Department, No. QIANKEHEZHICHEN[2022]YIBAN179; Foundation of Kweichow Moutai Hospital, No. MTyk2022-12; Foundation of Department of Health of Guizhou Province, No. gzwkj2021-036; and Guizhou Education Department, No. QIANJIAOHEKYZI[2018]239.
Informed consent statement: Informed written consent was obtained from the patient’s son for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read CARE Checklist (2016), and the manuscript was prepared and revised according to 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: Zhou-Xiong Xing, MD, Doctor, Department of Critical Care Medicine, The Affiliated Hospital of Zunyi Medical University, No. 149 Dalian Road, Zunyi 563000, Guizhou Province, China. xingzhouxiong111@126.com
Received: July 18, 2023
Peer-review started: July 18, 2023
First decision: August 9, 2023
Revised: August 22, 2023
Accepted: September 19, 2023
Article in press: September 19, 2023
Published online: October 16, 2023
Processing time: 87 Days and 5.9 Hours
Abstract
BACKGROUND

Central venous catheters (CVCs) often cause life-threatening complications, especially CVC-related bloodstream infection (CVC-BSI) and catheter-related thrombosis (CRT). Here, we report an unusual case of misplaced CVC-induced emphysematous thrombophlebitis, a rare but potentially lethal form of CRT and CVC-BSI characterized by both thrombosis and gas formation.

CASE SUMMARY

A 48-year-old male presented to the emergency room of a local hospital with sudden-onset headache and coma for 4 h. Computed tomography (CT) revealed right basal ganglia hemorrhage, so emergency decompressive craniotomy was performed and a CVC was inserted through the right subclavian vein for fluid resuscitation during anesthesia. Two days later, the patient was transferred to the intensive care unit of our hospital for further critical care. On day 9 after CVC insertion, the patient suddenly developed fever and hypotension. Point-of-care ultrasound (POCUS) demonstrated thrombosis and dilatation of the right internal jugular vein (IJV) filled with thrombosis. Ultrasonography also revealed that the CVC tip had been misplaced into the IJV and was surrounded by gas bubbles, which manifested as hyperechoic lines with dirty shadowing and comet-tail artifacts. Further CT scan confirmed air bubbles surrounding the CVC in the right neck. The final diagnosis was septic emphysematous thrombophlebitis induced by a misplaced CVC and ensuing septic shock. The responsible CVC was removed immediately. The patient received fluid resuscitation, intravenous noradrenaline, and a 10-d ultra-broad spectrum antibiotic treatment to combat septic shock. Both CVC and peripheral venous blood cultures yielded methicillin-resistant Staphylococcus cohnii. The patient was gradually weaned off vasopressors and the symptoms of redness and swelling in the right neck subsided within 7 d.

CONCLUSION

Emphysematous thrombophlebitis is a fulminant and life-threatening CVC-BSI associated with thrombosis and gas formation in the vein. A misplaced CVC may facilitate the development of emphysematous thrombophlebitis. POCUS can easily identify the artifacts produced by gas and thrombosis, facilitating rapid diagnosis at the bedside.

Keywords: Emphysematous thrombophlebitis; Septic thrombophlebitis; Central venous catheter; Ultrasound; Catheter-related thrombosis; Central venous catheter-related bloodstream infection; Case report

Core Tip: Central venous catheters (CVCs) often cause life-threatening complications, especially CVC-related bloodstream infection and catheter-related thrombosis. Emphysematous thrombophlebitis is a rare but life-threatening CVC-related bloodstream infection associated with thrombosis and gas formation in the vein. However, timely diagnosis remains a challenge for clinicians. Here, we report an unusual case of misplaced CVC-induced emphysematous thrombophlebitis rapidly diagnosed by point-of-care ultrasound (POCUS). POCUS revealed thrombosis surrounding the misplaced CVC in the right internal jugular vein and gas bubbles manifesting as hyperechoic lines with dirty shadowing and comet-tail artifacts. Knowledge of air-related artifacts may help physicians rapidly diagnose emphysematous thrombophlebitis.