Tension hemothorax due to iatrogenic subclavian artery perforation: Hybrid management of a very rare complication. (2019)

• Record Type: Journal Article
• Authors: Magnone, Stefano; Gotti, Riccardo; Giulii Capponi, Michela; Paderno, Nadiane; Maraglino, Cosimo; Cadei, Manuela; Mario, Consuelo; Lucianetti, Alessandro
• Is Part Of: International journal of surgery case reports. Volume 60(2019)
• Page Start: 323
• Page End: 326
• Publication Date: 2019
• Subjects: Hemothorax -- Obstructive shock -- Hemorrhagic shock -- Subclavian artery; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2019.06.024
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Tension hemothorax is a life threatening condition. Emergency thoracotomy can be accomplished in a hybrid room. Endovascular subclavian artery stenting is a good choice in an emergency setting. Abstract: Background: Tension hemothorax is a rare event, due to different causes: trauma, ruptured thoracic aorta aneurysms, or as a complication of central venous line placement due to inadvertent artery puncture or cannulation. Tension hemothorax leads to both hypovolemic and obstructive shock and can require emergency management. Presentation of case: A 63 years old lady underwent a complicated surgical procedure for a postoperative small bowel obstruction after radical cystectomy. During the procedure, a central venous catheter was placed, under ultrasound guidance, in the right jugular vein but an unknown puncture of the right subclavian artery occurred. In the early phase of the postoperative course, a hypovolemic/obstructive shock developed because of a tension hemothorax. The patient underwent an emergency thoracotomy in the hybrid room, followed by an endovascular repair of the arterial laceration. A recurrent hemothorax developed a few hours later because of an endoleak that was treated successfully with a second endovascular approach and a balloon dilatation of the stent. Conclusions: tension hemothorax due to inadvertent subclavian artery laceration can be life-threatening and should be managed in a hybrid room with endovascular and surgical capabilities.