CTICasesCarotid-Jugular Fistula and Mediastinal Hematoma
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Imaging findings
Chest radiograph and CT scan demonstrate pulmonary edema characterized by septal lines, ground-glass opacity, and perihilar consolidation. Following hemodialysis catheter placement, a subsequent radiograph reveals a widened, dense mediastinum, convex contours, and small apical caps. A follow-up CT scan confirms a large upper mediastinal hematoma with ill-defined soft tissue in the right carotid sheath. Common carotid ultrasound demonstrates flow in both the carotid artery and internal jugular vein with a visible communicating fistula.
Key takeaways
Mediastinal hematoma is a potential complication of central venous catheter placement, especially when the procedure is complicated. High suspicion for vascular injury should prompt cross-sectional imaging or ultrasound, which can identify iatrogenic carotid-jugular fistulas requiring intervention.
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