Timeline of Cellulitis and Late Development of Hydrothorax Induced by a Right‐Sided Central Venous Catheter

Abstract

We reported a case of 27-year-old woman who suffered a hydrothorax induced by a central venous catheter that had been placed to facilitate parenteral nutrition. The central venous catheter was inserted into the superior vena cava through the right subclavian vein. Chest radiograph after insertion revealed proper position of the tip. After a few days, the patient developed acute cellulitis of the right breast, and intravenous antibiotics were started. Four days later, 10 days after the insertion of the catheter, the patient suddenly developed dyspnea and tachycardia. Computed tomography scan of the chest showed massive pleural effusion in the right thorax and a mediastinal shift; the tip of the catheter had perforated the superior vena cava and was located in the right pleural space. Thoracic and subcutaneous drainage showed a fluid similar to parenteral nutrition. The continuous mechanical force of the catheter tip against the superior vena cava wall in combination with a hyperosmolar solution was considered to be the cause of the acute cellulitis and a delayed hydrothorax.

Hidrotórax secundário à nutrição parenteral: relato de caso

“…However, measures such as ventilatory and hemodynamic support, along with immediate suspension of TPN and chest tube drainage, were effective to prevent a bad outcome in this case. Fortunately, this event is rare, even though reported with increasing frequency, and may lead to death if not properly diagnosed and treated 11 . We emphasize the importance of confirming catheter position before its effective use.…”

An unusual complication of internal jugular vein catheterization

“…[2] Development of hydrothorax after CVC has also been described. [345] The reason for the hydrothorax is the catheter tip eroding the vascular wall and entering the mediastinum and pleural cavity. Most of the reports describe this complication to have occurred in a delayed fashion and more importantly the complication usually went unnoticed, resulting in a delay in diagnosis.…”