Delayed Tension Pneumothorax Detected 4 Days after Central Venous Catheterization - A case report -

Abstract

Pneumothorax is one of the most frequent complications of percutaneous central venous catheterization. Most significant pneumothoraces are easily detected on postcatheterization chest radiograph. However, we report a rare case of delayed tension pneumothorax detected 4 days after unsuccessful central venous catheterization via the infraclavicular subclavian vein, although initial postcatheterization and postoperative supine chest radiographs showed no active lesion.

Contralateral Tension Pneumothorax during One Lung Ventilation by a Univent® Tube

“…And pneumothorax is much more common following a subclavian rather than a jugular approach, and generally associated with difficult or multiple approaches. 7 However in the present case, we performed the central venous cannulation successfully at the first attempt by using the anterior approach to the right internal jugular vein. Therefore central venous cannulation cannot be presumed the cause of the pneumothorax.…”

Delayed pneumothorax and contralateral hydrothorax induced by a left subclavian central venous catheter: a case report

“…Furthermore, these authors argue that a small pneumothorax can be easily missed due to the typical poor quality of chest radiographs. Additionally, iatrogenic pneumothorax can have no initial symptoms, and moreover, a slow pleural air leak in association with positive pressure ventilation delays pneumothorax 3,6. Mechanical ventilatory therapy with high peak inspiratory pressure and mean airway pressure can cause barotraumas-related iatrogenic pneumothorax 10.…”

“… 1 It can occur within days after central venous catheterization, and its diagnosis can sometimes be delayed. 3 , 6 After the insertion of CVCs, it is currently a standard practice to confirm that the position of the catheter tip is appropriate and to eliminate radiologically detectable complications (e.g., pneumothorax and hemothorax) by CXR; 8 , 9 however, Molgaard et al 8 investigated 473 CVC insertion procedures, found no value in routine X-ray control after catheterization, and have since suggested that routine CXR be omitted from central venous catheterization practice. Furthermore, these authors argue that a small pneumothorax can be easily missed due to the typical poor quality of chest radiographs.…”

“…Additionally, iatrogenic pneumothorax can have no initial symptoms, and moreover, a slow pleural air leak in association with positive pressure ventilation delays pneumothorax. 3 , 6 Mechanical ventilatory therapy with high peak inspiratory pressure and mean airway pressure can cause barotraumas-related iatrogenic pneumothorax. 10 Lee et al 6 have also suggested that positive pressure ventilatory support in the ICU might contribute to large-sized tension pneumothorax.…”

“…We searched Medline reports from the last 30 years and found very few cases that reported delayed pneumothorax and hydrothorax caused by catheterization. Most of these reported cases observed pneumothorax and/or hydrothorax on the same side as the CVC, 3 , 5 , 6 and only one case developed hydrothorax as a delayed complication on the opposite side as the catheter. 7 We did not detect the simultaneous occurrence of delayed pneumothorax and contralateral hydrothorax in a single case.…”