Pneumomediastinitis following right subclavian vein central line insertion

وائل صدقه's picture
Journal Title, Volume, Page: 
Vol 6, No 6
Year of Publication: 
Wael Abdulla Sadaqa
Current Affiliation: 
Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestin
Preferred Abstract (Original): 

Background: Complications related to central venous catheters in the intensive care unit can be fatal. We recently had a case of pneumomediastinitis. Case Report: An 18 years old lady with acute myeloid leukemia to An-Najah National University Hospital for a second course chemotherapy. At the day of admission central line insertion is planned for starting the chemotherapy. The central line was inserted in right subclavian vein.  One hour after the insertion the patient complained of mild chest pain. Difficulty of breathing and mild tachypnea.  Anteroposterior chest radiography does not reveal neumothorax, infiltration, consolidation or collapse. The chest CT scan reported that pneumomediastinum was detected in superior and anterior of mediastinum. Minimal pleural effusion was also detected in right lung, especially in the dependent area. The tip of the catheter was seen lying free in the left side of the mediastinum as a sign of perforation with mild air collection as sign of pneumomediastinum. The central venous line was removed after proving its malpositioning. The patient recovered with conservative treatment after two days, and new central venous line was inserted with guidance of ultra sound, and chemotherapy was started. Conclusions:  This case highlights the importance of inserting the central line under the guidance of ultrasound and clinical importance of comparing CT scan to the chest x-ray accuracy in diagnosing the chest complications.