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Clinical Problem Solving: Radiology
November 2007

Radiology Quiz Case 1: Diagnosis

Author Affiliations

Copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2007

Arch Otolaryngol Head Neck Surg. 2007;133(11):1164. doi:10.1001/archotol.133.11.1164

The benefit of central venous access is well recognized in the treatment of many malignant disorders and chronic diseases. Central venous catheterization is indicated for central venous pressure monitoring, administration of phlebitic medications, rapid fluid replacement, dialysis, prolonged intravenous therapy, and cardiopulmonary resuscitation. It is also used in cases in which total parental nutrition is required.1,2 Central venous catheterization through a subclavian or jugular venous approach has been commonly performed over the past 2 decades in emergency departments and intensive care units, where the vast majority of venous approaches are performed in a “blind” manner without fluoroscopic or echo-Doppler guidance, thus increasing the risk of complications.3 Catheter-related complications could result from (1) technical problems at the time of insertion, (2) repeated usage, or (3) just the mere presence of a foreign body in the vascular system. Immediate complications account for 0.3% to 12% of the maneuvers and mostly involve pneumothoraces and vascular bleeding, such as venous hematoma, extrapleural hematoma, hemomediastinum, or subclavian artery perforation.4-7 Early recognition of the clinical and radiologic signs of any complication is essential; therefore, postinsertion chest radiography should be performed, with special attention to the presence of pneumothorax, the extrapleural apical cap, and mediastinal widening.2 Identification of a misplaced catheter or any iatrogenic perforation of the subclavian artery or central veins mandates the performance of computed tomography of the chest and selective angiography or venography.