Massive hydrothorax following subclavian vein catheterization

Abstract

Since the introduction of central venous catheterization for monitoring of the venous pressure, fluid infusion and hyperalimentation, the literature has been full of serious life-threatening complications. Of these complications is the false positioning of the central venous catheter and subsequent development of pleural effusion. In this report we are describing a case of iatrogenic massive pleural effusion following subclavian vein catheterization necessitating intercostal tube drainage and mechanical ventilation. The case highlights the importance of ensuring adequate positioning of the catheter after insertion through aspiration of venous blood, immediate post insertion X-ray and the utilization of ultrasound guidance in cases with expected difficult catheterization.

Figure 1

Revealing a normal anteroposterior chest radiograph before subclavian catheterization (panel A). chest X-ray performed after catheterization revealing massive left sided pleural effusion with mediastinal shift to the left side. Arrows point to the course of the catheter.

Figure 2

Demonstrating the site of the pleurocutaneous fistula.