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Background and Aims Lung ultrasound has become standard practice following central venous catheter cannulation to detect pneumothorax. In addition to this complication, we present a case report of an iatrogenic subclavian artery hematoma visualized through thoracic ultrasound, which was not identified in the chest radiography.
Methods We present the case of a 58-year-old woman, ASA III, diagnosed with stage IV colon cancer resulting in intestinal occlusion and contained perforation. The patient was proposed for a right colectomy and a totally implantable central venous access device for chemoterapy. A balanced general anesthesia technique was employed, and an ultrasound-guided bilateral rectus sheath single-shot block was performed for analgesic purposes. The central venous implantable catheter placement needed several attempts, with iatrogenic subclavian artery puncture. After successful catheter placement, subsequent post-procedure lung ultrasound revealed the presence of lung sliding with hypoechoic displacement of the visceral and parietal pleura at the level of the first and second ribs on the same side as the procedure, compatible with an hematoma. A thoracic radiograph performed thereafter did not identify hemothorax; however, it did identify improper final positioning of the tip of catheter, specifically at the contralateral subclavian vein.
Conclusions This case report highlights the utility of lung ultrasound in identifying complications of central venous catheterization, such as hematoma following iatrogenic artery puncture. While thoracic radiography remains the standard for tip localization and exclusion of pneumothorax, lung ultrasound serves as an additional valuable tool in detecting other potential complications.
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