CTICasesHemodialysis Catheter Perforation into the Pleural Space
Imaging findings
During fluoroscopic placement of a hemodialysis catheter via a left internal jugular approach, contrast injection showed abnormal opacification with backflow along the heart and mediastinum, raising concern for SVC perforation despite an apparently well-positioned catheter. CT confirmed contrast in the right pleural space, indicating the catheter had passed into the pleura, effectively a pleurogram.
Key takeaways
Central venous catheters can perforate into the pleural space even when placed under fluoroscopy, and observing contrast spilling out during the procedure is an important real-time clue. Because of the low venous pressure, such perforations can often be managed conservatively by carefully withdrawing the line, with the extravasated contrast and fluid resorbing over time.
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