CTICasesIatrogenic Superior Vena Cava Rupture
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Imaging findings
Initial fluoroscopic imaging during an endovascular procedure shows a balloon catheter inflated within a narrowed segment of the superior vena cava (SVC) in a patient with multiple pacemaker wires. Subsequent imaging reveals sudden paratracheal stripe thickening, indicating a large paratracheal hematoma. A chest CT confirms a frank rupture of the superior vena cava.
Key takeaways
Endovascular balloon dilation of a chronically stenosed superior vena cava, especially in patients with indwelling pacemaker wires or hemodialysis access, carries a high risk of iatrogenic vessel rupture. Sudden hypotension during such procedures should raise immediate suspicion for venous rupture and mediastinal hemorrhage, requiring urgent cardiothoracic surgical repair.
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