PMC4446665_01
Left subclavian catheter is seen within the left brachycephalic vein with a chest CT scan with contrast; there is perforation of the distal brachycephalic vein (white arrow) and beyond this point the catheter is seen running through the mediastinum, anteriorly and then laterally to the superior vena cava. There is evidence of pneumomediastinum anteriorly. No evidence of significant mediastinal hematoma or hemopericardium. No pneumothorax.
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Computed tomography of the chest confirmed perforation of the innominate vein (Fig. 1).
A single digitally subtracted spot fluoroscopic image centered over the inferior mediastinum was obtained intraoperatively and submitted for interpretation. A central venous catheter is seen coursing along the expected location of the left innominate vein and SVC, its distal tip at the level of the inferior SVC. Contrast injection through the catheter tip reveals extravascular contrast trapped within the soft tissues of the mediastinum (black arrow).
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Vascular surgery performed contrast angiography via the subclavian hemodialysis catheter confirming extravascular fluid trapping suggesting perforation (Fig. 2).