Chest X-Ray appearance of total opacification of the hemithorax following central venous line insertion: A cautionary tale

Abstract

Introduction: central venous line insertion is associated with significant complications. Procedural complications relating to lung injury is relatively common, and these may require tube thoracostomy for management. Although a postprocedure chest X-ray is routinely undertaken in many centers, erroneous interpretation can lead to potentially incorrect and unnecessary further intervention. case report: We report a case of a 25-year-old male who had a central venous line inserted, with the chest X-ray appearance of a massive opacification of the hemithorax misdiagnosed as a hemothorax and planned tube thoracostomy. It was subsequently confirmed as a complete pulmonary collapse caused by a large mucus plug with obstruction of the main Victor Kong1, Leah Naidoo2, Damon Jeetoo3, George Oosthuizen4, Grant Laing5, Damian Clarke5 Affiliations: 1MBChB, Surgical Registrar, Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, Edendale Hospital, Pietermaritzburg, KwaZulu Natal, South Africa; 2MBChB, Surgical House Officer, Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, Edendale Hospital, Pietermaritzburg, KwaZulu Natal, South Africa; 3MBChB, Radiology Registrar, Department of Radiology, Edendale Hospital, Pietermaritzburg, KwaZulu Natal, South Africa; 4FCS(SA), Senior Consultant Trauma Surgeon, Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, Edendale Hospital, Pietermaritzburg, KwaZulu Natal, South Africa; 5FCS(SA), Consultant Trauma Surgeon, Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, Edendale Hospital, Pietermaritzburg, KwaZulu Natal, South Africa. Corresponding Author: Dr Victor Kong, Department of General Surgery, Edendale Hospital, Edendale Main Road, Pietermaritzburg, 3200. Email: victorywkong@yahoo.com Received: 29 November 2012 Accepted: 04 June 2013 Published: 01 December 2013 bronchus. this completely resolved after an awake flexible bronchoscopic clearance, without the need for tube thoracostomy. conclusion: Whilst chest X-ray allows identification of most mechanical complications of central venous line insertion, accurate interpretation and correct clinical correlation are absolutely critical in order to avoid unnecessary interventions.

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@inproceedings{Kong2014ChestXA, title={Chest X-Ray appearance of total opacification of the hemithorax following central venous line insertion: A cautionary tale}, author={Victor Y. Kong and Leah C Naidoo and Damon Jeetoo and George V. Oosthuizen and Grant Llewellyn Laing and Damian Clarke}, year={2014} }