SummaryWe report a case of delayed pneumothorax, central venous catheter migration and iatrogenic hydrothorax in a 22-year-old female. The left subclavian central venous catheter initially trans®xed the lung apex; pneumothorax occurred 24 h later following initiation of positive pressure ventilation. Lung collapse as a result of the pneumothorax caused catheter migration and hydrothorax. Catheter removal and chest drainage led to an uneventful recovery.Keywords Complications; delayed pneumothorax, hydrothorax. Veins; subclavian, cannulation. Pneumothorax is a well-recognised complication of central venous cannulation, occurring in up to 3% of cases, depending on the experience of the operator [1,2]. Routine chest radiography following insertion may not initially demonstrate any pathology [3]. We report a patient whose initial chest radiograph was normal following insertion of a left subclavian central venous catheter. Subsequent pneumothorax formation associated with lung apex trans®xation by the catheter led to catheter migration and iatrogenic hydrothorax. A Medline search of the last 20 years did not reveal any similar cases. Case historyA 22-year-old female was admitted postoperatively to the intensive care unit with biventricular failure following left thoracotomy and pericardial window for pericardial effusion.To facilitate haemodynamic monitoring and inotropic support, a 7 French 20 cm triple-lumen central venous catheter was inserted over a 0.83 mm spring guidewire passed through a 6.35 cm 18 G needle, via a left subclavian approach. The left subclavian vein was punctured at the ®rst attempt, and no technical problems were encountered. Blood was freely aspirated from all three ports and a normal central venous pressure tracing was obtained. An initial chest radiograph showed the catheter in an acceptable position in the superior vena cava with no evidence of pneumothorax.As a result of deterioration in the patient's condition, tracheal intubation and intermittent positive pressure ventilation were undertaken the following day.A chest radiograph taken 2 days after the initial central line insertion showed a small apical left pneumothorax which was not causing any clinical compromise (Fig. 1). The following day the patient had worsening gas exchange and a chest radiograph taken at this time indicated a large, left pleural effusion with an enlarged area of pneumothorax. The central venous catheter was noted to be looped in the thoracic cavity. Its tip had migrated distally within the superior vena cava (Fig. 2). Pressure transduction of the distal catheter lumen demonstrated a normal central venous pressure tracing.The central venous catheter was removed and an apical intercostal catheter inserted, which drained milky¯uid. Propofol had previously been infused through the proximal catheter port. The effusion subsequently cleared, lung expansion returned to normal and the patient made an otherwise uneventful recovery. Q 1999 Blackwell Science Ltd DiscussionThis case illustrates an interesting complication of...

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