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Bedside ultrasonic detection of massive hemothorax due to superior vena cava perforation after hemodialysis catheter insertion.
Acta Anaesthesiol Taiwan 2009; 47(2):95-8AA

Abstract

Hemothorax resulting from perforation of a great vessel is an uncommon but life-threatening complication which may occur during central venous insertion of a hemodialysis catheter. We describe a 78-year-old uremic female who developed unexplained and refractory shock on the completion of percutaneous placement of a hemodialysis catheter in the right subclavian vein under general anesthesia. Bedside transthoracic ultrasound revealed a large anechoic area above the right hemidiaphragm, suggestive of the presence of extensive hemothorax. The diagnosis was further confirmed by prompt drainage of fresh blood from the right thoracostomy tube. Emergent thoracotomy was performed and perforation of the superior vena cava was identified. Hemodynamic stability was restored after surgical repair of the injured vessel, aggressive volume resuscitation and inotropic/vasopressor treatment. This case suggests that portable ultrasonography is an invaluable bedside tool which allows anesthesiologists to made reliable and prompt diagnosis of potentially fatal complications, such as perforation of great central vein due to inadvertent cannulation.

Authors+Show Affiliations

Department of Anesthesiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

19527972

Citation

Wang, Chi-Ying, et al. "Bedside Ultrasonic Detection of Massive Hemothorax Due to Superior Vena Cava Perforation After Hemodialysis Catheter Insertion." Acta Anaesthesiologica Taiwanica : Official Journal of the Taiwan Society of Anesthesiologists, vol. 47, no. 2, 2009, pp. 95-8.
Wang CY, Liu K, Chia YY, et al. Bedside ultrasonic detection of massive hemothorax due to superior vena cava perforation after hemodialysis catheter insertion. Acta Anaesthesiol Taiwan. 2009;47(2):95-8.
Wang, C. Y., Liu, K., Chia, Y. Y., & Chen, C. H. (2009). Bedside ultrasonic detection of massive hemothorax due to superior vena cava perforation after hemodialysis catheter insertion. Acta Anaesthesiologica Taiwanica : Official Journal of the Taiwan Society of Anesthesiologists, 47(2), pp. 95-8. doi:10.1016/S1875-4597(09)60032-1.
Wang CY, et al. Bedside Ultrasonic Detection of Massive Hemothorax Due to Superior Vena Cava Perforation After Hemodialysis Catheter Insertion. Acta Anaesthesiol Taiwan. 2009;47(2):95-8. PubMed PMID: 19527972.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Bedside ultrasonic detection of massive hemothorax due to superior vena cava perforation after hemodialysis catheter insertion. AU - Wang,Chi-Ying, AU - Liu,Kang, AU - Chia,Yuan-Yi, AU - Chen,Chen-Hsiu, PY - 2009/6/17/entrez PY - 2009/6/17/pubmed PY - 2009/8/26/medline SP - 95 EP - 8 JF - Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists JO - Acta Anaesthesiol Taiwan VL - 47 IS - 2 N2 - Hemothorax resulting from perforation of a great vessel is an uncommon but life-threatening complication which may occur during central venous insertion of a hemodialysis catheter. We describe a 78-year-old uremic female who developed unexplained and refractory shock on the completion of percutaneous placement of a hemodialysis catheter in the right subclavian vein under general anesthesia. Bedside transthoracic ultrasound revealed a large anechoic area above the right hemidiaphragm, suggestive of the presence of extensive hemothorax. The diagnosis was further confirmed by prompt drainage of fresh blood from the right thoracostomy tube. Emergent thoracotomy was performed and perforation of the superior vena cava was identified. Hemodynamic stability was restored after surgical repair of the injured vessel, aggressive volume resuscitation and inotropic/vasopressor treatment. This case suggests that portable ultrasonography is an invaluable bedside tool which allows anesthesiologists to made reliable and prompt diagnosis of potentially fatal complications, such as perforation of great central vein due to inadvertent cannulation. SN - 1875-4597 UR - https://www.unboundmedicine.com/medline/citation/19527972/Bedside_ultrasonic_detection_of_massive_hemothorax_due_to_superior_vena_cava_perforation_after_hemodialysis_catheter_insertion_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1875-4597(09)60032-1 DB - PRIME DP - Unbound Medicine ER -