Asymptomatic Mediastinal Hematoma as a Complication of Ultrasound-Guided Internal Jugular Vein Catheterization

Abstract

Central venous catheterization is a frequently performed procedure in the intensive care units (ICU) for various treatments such as iv therapy, parenteral nutrition and hemodialysis but occasionally encountered complications can be fatal. Therefore, safe insertion with confirmation of correct positioning of the catheter is vital. Ultrasound (US)-guided insertion of catheters has been used widely, and its safety and efficacy have been demonstrated in several studies. However, this technique is not free from complications, such as carotid artery puncture, hemothorax, pneumothorax and infection. In this case, anterior mediastinal hematoma proceeded after USguided internal jugular vein (IJV) catheterization.

Life‐threatening airway obstruction due to retropharyngeal and cervicomediastinal hematomas following transjugular intrahepatic portosystemic shunt procedure for acute variceal bleeding in cirrhosis.

“…2 Although formation of a hematoma due to the bleeding complication at this puncture site is rare, 3,4 many unusual case reports are found in the literature. [5][6][7][8] Such hematomas could occur in the cervical, 5,6,9,15,18,20 retropharyngeal, 10,11,12,16 or mediastinal 7,13,14,17,19,21,22,23 regions, with the presentation varying widely, from asymptomatic 9,11,17,18,20,21 to life-threatening. [5][6][7]12,13,15,16,19,23 However, it is extremely rare that the hematoma simultaneously involves the retropharyngeal and cervicomediastinal regions, and causes life-threatening airway obstruction after internal jugular vein catheterization.…”