Breathlessness after a central line

A woman in her 30s developed acute respiratory distress and persistent hypotension in the minutes following surgery for ovarian cancer. A central line had been placed during the surgery. On auscultation of the chest, breath sounds were reduced on the right side. A chest radiograph showed a large opacity in the right lung field, with the trachea displaced to the left. Haemothorax was suspected and a chest drain inserted, but only a small amount of fluid was drained. Subsequent computed tomography (CT) imaging (fig 1) showed an extrapleural haematoma in the right thorax, displacing the extrapleural fat with an associated pleural effusion. Extrapleural haematoma is caused by trauma to the chest wall1 and is a rare complication of central venous catheterisation. This patient’s haematoma was most likely caused by a puncture of the subclavian vein during catheterisation.bmj;383/oct12_6/e075124/F1F1f1Fig 1CT image of the chest, showing haematoma (white asterisk), fat (black arrows), and…
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