Hemomediastinum resulting from subclavian artery laceration during internal jugular catheterization

Abstract

The complications associated with internal jugular vein catheterization are inadvertent arterial puncture, pleural and mediastinal injuries, pneumothorax, hemothorax, and hemomediastinum. Complications caused by laceration of a subclavian artery are rare. We present a case of hemomediastinum resulting from laceration of the subclavian artery during central venous catheterization. After right internal jugular vein catheterization, the left lateral decubitus position was maintained for 6 h during surgery. The severe hypotension was first noted in the supine position after transfer to the postanesthesia care unit. Chest radiograph showed a bulging of the right upper mediastinum. During the upper half sternotomy, a 5-mm long laceration was found at the posteroinferior side of the right subclavian artery near its origin from the innominate artery.

Implications: The authors describe the delayed presentation of hemomediastinum resulting from subclavian artery laceration after internal jugular vein catheterization.