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. 2019:60:323-326.
doi: 10.1016/j.ijscr.2019.06.024. Epub 2019 Jun 20.

Tension hemothorax due to iatrogenic subclavian artery perforation: Hybrid management of a very rare complication

Stefano Magnone  1 , Riccardo Gotti  2 , Michela Giulii Capponi  3 , Nadiane Paderno  3 , Cosimo Maraglino  2 , Manuela Cadei  4 , Consuelo Mario  4 , Alessandro Lucianetti  3
Affiliations

Tension hemothorax due to iatrogenic subclavian artery perforation: Hybrid management of a very rare complication

Stefano Magnone et al. Int J Surg Case Rep. 2019.

Abstract

Background: Tension hemothorax is a rare event, due to different causes: trauma, ruptured thoracic aorta aneurysms, or as a complication of central venous line placement due to inadvertent artery puncture or cannulation. Tension hemothorax leads to both hypovolemic and obstructive shock and can require emergency management.

Presentation of case: A 63 years old lady underwent a complicated surgical procedure for a postoperative small bowel obstruction after radical cystectomy. During the procedure, a central venous catheter was placed, under ultrasound guidance, in the right jugular vein but an unknown puncture of the right subclavian artery occurred. In the early phase of the postoperative course, a hypovolemic/obstructive shock developed because of a tension hemothorax. The patient underwent an emergency thoracotomy in the hybrid room, followed by an endovascular repair of the arterial laceration. A recurrent hemothorax developed a few hours later because of an endoleak that was treated successfully with a second endovascular approach and a balloon dilatation of the stent.

Conclusions: tension hemothorax due to inadvertent subclavian artery laceration can be life-threatening and should be managed in a hybrid room with endovascular and surgical capabilities.

Keywords: Hemorrhagic shock; Hemothorax; Obstructive shock; Subclavian artery.

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Figures

Fig. 1
Fig. 1
Hemothorax on chest X-ray.
Fig. 2
Fig. 2
Right tension hemothorax. See the tracheal deviation toward the left.
Fig. 3
Fig. 3
Massive bleeding from the right subclavian artery on angiography.
Fig. 4
Fig. 4
Balloon dilatation to deploy the stent.
Fig. 5
Fig. 5
CT scan showing leakage from the stent, due to reperfusion of the vertebral artery a few hours after the angiographic procedure.
Fig. 6
Fig. 6
Second balloon dilatation to control retrograde bleeding from the vertebral artery.
See this image and copyright information in PMC

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