CTICasesIntramural Hematoma of the Brachiocephalic and Carotid Arteries from Attempted Central Line Placement
Imaging findings
In a patient being evaluated for liver transplantation, incidental right middle lobe atelectasis from secretions was noted, along with an opacity in the left supraclavicular region and a mural abnormality of the distal aortic arch near the origin of the left subclavian artery, extending toward the carotid artery.
Key takeaways
Review of the medical record revealed five unsuccessful attempts at internal jugular central venous catheter placement shortly before imaging, suggesting that a guidewire or needle caused vascular injury with resultant intramural hematoma of the brachiocephalic and carotid arteries rather than vasculitis. This underscores the importance of obtaining a full procedural history before over-interpreting an unexplained arterial wall abnormality, and highlights an iatrogenic vascular injury from difficult central line placement.
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