Importance of Sonography for Guiding Central Venous Cannulation in Patients with Neurofibromatosis

Abstract

A 15-year-old boy with neurofibromatosis type 1 (NF1) was referred to us for central venous catheter insertion, and on ultrasound of the neck, he was found to have extensive involvement of the brachial plexus due to the nerve sheath tumour. Multiple hypoechogenic lesions resembling the internal jugular vein and internal carotid artery were visualised and could be differentiated from the vessels by Doppler ultrasound. The importance of analyzing sonographic images of nerve sheath tumours, which can mimic blood vessels, and the importance of Doppler ultrasound for guiding central venous catheters in such patients to avoid nerve injury are discussed in this case report. Keywords: Neurofibromatosis, ultrasound, central venous cannulationNörofibromatoz tip 1 olan 15 yaşında bir erkek hasta santral venöz kateter takılması için bize yönlendirildi. Hastanın boyun ultrasonunda sinir kılıfı tümöründen dolayı yaygın brakiyal pleksus tutulumu izlendi. İnternal juguler ven ve internal karotis arteri anımsatan çoklu hipoekojen lezyonlar görüldü ve Doppler ultrason ile damarlardan ayırt edilebildi. Bu vaka sunumunda, kan damarlarını taklit edebilen sinir kılıfı tü-mörlerinin sonografik görüntülerinin önemi ve bu hastalarda sinir hasarlarından kaçınmak için santral venöz kateterlerine rehberlik etmesi açısından Doppler ultrasonun önemi tartışıl-maktadır.Anahtar Sözcükler: Nörofibromatoz, ultrason, santral venöz kanülasyon Abstract / Öz

Brachial Plexus Injury due to Central-line Insertion during Kypho-scoliosis Deformity Correction

“…Although the success rate of IJV cannulation using anatomical landmarks is 95%, various parameters such as obesity, neck deformity, and inability to lie flat may make the procedure difficult [ 12 , 13 ]. Ultrasound may be of help in such cases to prevent brachial plexus injury [ 12 , 14 ]. It was an important learning point from our case to use USG from the beginning while inserting IJV cannulation if anatomical landmarks are altered.…”

Ultrasound a Game Changer

“…Case reports, case series, and randomized trials have looked into many of the applications of ultrasound-guidance, and more of these are published on a routine basis. In the current issue, Mohan and Nisa report successful central venous cannulation under ultrasound guidance in a young boy with neurofibromatosis type 1 (NF1) (3). This patient presented with a nerve sheath tumor extensively invading the brachial plexus and almost precluding the ability to insert a central venous cannula in the internal jugular vein for fear of neurological injury.…”