Background: Complications related to central venous catheters in the intensive care unit can
be fatal. Case Report: An 18 years old lady with acute myeloid leukemia was admitted to An-Najah National
University Hospital for a second course chemotherapy. On the day of admission, central
line insertion was planned for starting the chemotherapy. The central line was inserted
in right subclavian vein. One hour after the insertion, the patient complained of
mild chest pain, difficulty breathing, and mild tachypnea. Anteroposterior chest radiography
did not reveal neumothorax, infiltration, consolidation, or collapse. The chest computed
tomography scan (CT) detected anterior and superior pneumomediastinum. Minimal pleural
effusion was also detected in the right lung, especially in the dependent area. The
tip of the catheter was seen lying free in the left side of the mediastinum indicative
of perforation with mild air collection suggestive of pneumomediastinum. The central
venous line was removed after proving its malpositioning. The patient recovered within
two days with conservative treatment and a new central venous line was inserted with
guidance of ultrasound. Chemotherapy was then resumed. Conclusions: This case highlights the importance of inserting the central line under the guidance
of ultrasound and the superiority of CT scan over the chest x-ray accuracy in diagnosing
the chest complications.
Key-words:
Pneumomediastinitis - Cenral vein cannulation - Iatrogenic. Subclavian
