Therapeutic strategy of central vein perforation accompanied by a mediastinal lesion after catheterization

Abstract

Central vein perforation associated with a mediastinal lesion is a rare complication of catheterization. A 50-year-old woman was diagnosed with chronic kidney disease and required hemodialysis treatment. The patient developed central vein injury during attempted placement of a double-channel catheter. A computed tomographic scan and venography showed that the catheter had punctured the mediastinum from the central vein. After comprehensive assessment and multidisciplinary consultation, percutaneous catheter thrombin injection with follow-up balloon dilatation under fluoroscopy guidance successfully fixed the perforation. We summarize the therapeutic strategy of this complication and other treatment options, and discuss the related literature of central vein injury.

Keywords: Catheterization; central vein injury; hemodialysis; hemorrhage; kidney disease; mediastinum; thrombin.

Figure 1.

(a) Axial and (b) coronal computed tomographic images of the chest show the anterior mediastinum. There is a small amount of pneumomediastinum in the mediastinum, while the corresponding fat tissue is not clear. The lower part of the catheter (arrowhead) penetrates into the anterior superior mediastinum

Figure 2.

Angiography shows that the venous catheter tip is located in the mediastinum and a false lumen (arrowhead) is present in the interlayer of the left brachiocephalic veins (2.2 × 7.64 cm)

Figure 3.

(a) Angiography shows (arrowhead) an 8 × 7-mm thrombus in the brachiocephalic vein with a focal stenotic segment. (b) Angiography show balloon dilatation for hemostasis by intravascular compression