An-Najah Staff

Background: Complications related to central venous catheters in the intensive care unit can be fatal.
Case Report: An 18 years old lady with acute myeloid leukemia was admitted to An-Najah National University Hospital for a second course chemotherapy. On the day of admission, central line insertion was 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 breathing, and mild tachypnea.  Anteroposterior chest radiography did not reveal neumothorax, infiltration, consolidation, or collapse. The chest computed tomography scan (CT) detected anterior and superior pneumomediastinum. Minimal pleural effusion was also detected in the right lung, especially in the  dependent area. The tip of the catheter was seen lying free  in the left side of the mediastinum indicative of perforation with mild air collection suggestive of pneumomediastinum. The central venous line was removed after proving its malpositioning. The patient recovered within two days with conservative treatment and a new central venous line was inserted with guidance of ultrasound. Chemotherapy was then resumed.
Conclusions: This case highlights the importance of inserting the central line under the guidance of ultrasound and the superiority of CT scan over the chest x-ray accuracy in diagnosing the chest complications.