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Images in emergency medicine

Unexpected failure of central venous

catheterisation for resuscitation12

vessels can induce unexpected failure of central venous catheterisation.

J S You,1 Y E Chung,2 J Y Park,3 J W Park,4 T S Hwang4

1

A 59-year-old man presented to the emergency department

with fever over the past 3 days. The medical history was noncontributory. The patient had a cough with sputum and dizziness. On initial examination, the vital signs were as follows:
blood pressure of 80/60 mm Hg, pulse rate 112 beats/min,
respiration rate 24 breaths/min and temperature 40.28C. There
were coarse lung sounds with rales at the right lung area.
Central venous catheterisation was performed for measurement of the central venous pressures and rapid uid resuscitation.1 However, venous access of the right subclavian vein
failed because the catheter could not be advanced. In addition,
venous access of the left subclavian vein also failed for
some unknown reason. The tip of the central venous line was
inappropriately place in the right lung (gure 1A). A contrastenhanced CT was performed to determine the cause of septic
shock.
These CT ndings likely explained the unexpected failure of
central venous catheterisation (gure 1B,C). Emergency
physicians should consider that mass lesions in chest involving

Department of Emergency Medicine and Critical Care Medicine, Seo-Ulsan Boram

Hospital, Ulsan, Republic of Korea; 2Department of Diagnostic Radiology, Seoul
National University College of Medicine, Seoul, Republic of Korea; 3Department of
Internal Medicine, Kosin University College of Medicine, Busan, Republic of Korea;
4
Department of Emergency Medicine, Changwon Fatima Hospital, Changwon,
Republic of Korea
Correspondence to Jong Woo Park, Department of Emergency Medicine,
Changwon Fatima Hospital, 212, Myeongseo-Dong, Changwon 641-560, Republic of
Korea; erman@naver.com
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; not externally peer reviewed.
Accepted 17 December 2009
Emerg Med J 2010;27:340.
doi:10.1136/emj.2009.090076

REFERENCE
1.

Graham AS, Ozment C, Tegtmeyer K, et al. Videos in clinical medicine. Central

venous catheterization. N Engl J Med 2007;356:e21.

Figure 1 The tip of the central venous line (arrow) was inappropriately place in the right lung. (A) A suspicious bulging contour at the right upper
mediastinum (arrowhead) was noted and could have been a tortuous aorta. However, considering the patients age, a mass lesion was also considered
as a possibility. The CT scan revealed a superior sulcus tumour (arrowhead) involving the right upper mediastinum and chest wall that compressed the
right jugular vein, subclavian artery and upper portion of superior vena cava (B, C).

340

Emerg Med J May 2010 Vol 27 No 5

Downloaded from emj.bmj.com on June 26, 2013 - Published by group.bmj.com

Unexpected failure of central venous

catheterisation for resuscitation
J S You, Y E Chung, J Y Park, et al.
Emerg Med J 2010 27: 340 originally published online April 1, 2010

doi: 10.1136/emj.2009.090076

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