Hemodynamic Collapse Due to Unrecognized Hemothorax Following Central Venous Catheter Insertion in a Resource-Limited Setting: A Case Report

TL;DR

A patient developed a serious lung complication after a routine catheter procedure, highlighting the need for better monitoring and guidance techniques.

Contribution

Highlights the importance of using imaging guidance to prevent major complications during central venous catheter placement.

Findings

A 71-year-old male developed hemothorax after CVC placement, causing hemodynamic collapse.

Early recognition and management of hemothorax were critical for successful resuscitation.

Use of ultrasonic or fluoroscopic guidance could reduce major mechanical complications.

Abstract

Central venous catheter (CVC) placement is a routine but not risk-free procedure, with potential complications including hemothorax. We present a case of a 71-year-old male with coronary artery disease (CAD) who developed intraoperative hemothorax following internal jugular vein CVC placement. The patient experienced profound hypotension during surgery, prompting intervention. Subsequent exploration revealed a small abrasion on the right lung surface caused by an inadvertent initial CVC puncture, leading to hemothorax. The patient was successfully resuscitated, and prompt identification and management of hemothorax were critical. This case emphasizes the importance of vigilance, communication, and early consideration of complications like hemothorax post-CVC placement when unexplained hemodynamic instability occurs. We believe that the use of ultrasonic guidance or fluoroscopic guidance during CVC placement could reduce unusual major mechanical complication rates even during emergencies.

Figures