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Anesth Analg 2004;99:31-35
© 2004 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000117148.40842.CA

CARDIOVASCULAR ANESTHESIA

Life-Threatening Mediastinal Hematoma Caused by Extravascular Infusion Through a Triple-Lumen Central Venous Catheter

Matthias Hohlrieder, MD, Rosmarie Oberhammer, MD, Ingo H. Lorenz, MD, Josef Margreiter, MD, Gabriele Kühbacher, MD, and Christian Keller, MD

Department of Anesthesiology and Critical Care Medicine, University of Innsbruck, Austria

Address correspondence and reprint requests to Matthias Hohlrieder, MD, Department of Anesthesiology and Critical Care Medicine, University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria. Address e-mail to matthias.hohlrieder{at}uibk.ac.at

We report a case of life-threatening mediastinal hematoma in a 6-mo-old girl during surgical correction of scaphocephaly. The hematoma was caused by extravascular infusion via the proximal lumen of a dislocated triple-lumen central venous catheter (CVC). Worsening symptoms of hypovolemia and ventilation problems prompted performance of transesophageal echocardiography, which reliably and quickly allowed us to exclude pericardial tamponade and detect a mediastinal hematoma. The anesthesiologist should be alert when a patient with a CVC develops acute cardiopulmonary or respiratory symptoms. Repeated aspirations of blood, especially after major positional changes and before giving large quantities of fluid or blood, should be performed to detect secondary malposition of the CVC.

IMPLICATIONS: This pediatric case report demonstrates a life-threatening intraoperative mediastinal hematoma caused by infusion of packed erythrocytes through the extravascular proximal lumen of a partially dislocated central venous catheter. Transesophageal echocardiography facilitated rapid intraoperative diagnosis.




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2004 by the International Anesthesia Research Society.