title: Left brachiocephalic vein perforation: computed tomographic features and treatment considerations.
abstract: OBJECTIVE
  To report the clinical and computed tomographic findings of 5 cases of left brachiocephalic vein perforation (LBCVP).
  
  
  METHODS
  The clinical and imaging features of 5 patients with LBCVP (1 woman, 4 men; mean age, 57.6 years) encountered over the last 2 decades were reviewed.
  
  
  RESULTS
  Etiologies included left jugular central catheter penetration in 2 patients, blunt trauma in 2, and idiopathic in 1. All patients manifested acute chest pain with a widened mediastinum on chest radiographs. Characteristic computed tomographic features included a cord-like hematoma along the course of the left brachiocephalic vein associated with a left upper anterior mediastinal hematoma (AMH). Three clinically stable patients with AMH smaller than 5 cm convalesced after conservative treatment and 2 clinically unstable patients with AMH bigger than 7 cm recovered well after surgery.
  
  
  CONCLUSIONS
  Computed tomography is helpful in diagnosing LBCVP. Under close surveillance, patients with stable LBCVP with AMH smaller than 5 cm may be managed conservatively. However, emergency surgery is warranted if there are any signs of instability.
authors.affiliation: Department of Radiology, College of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University, Kaohsiung 833, Taiwan. sfatko@adm.cgmh.org.tw
authors.forename: Sheung-Fat
authors.initials: SF
authors.lastname: Ko
authors.forename: Shu-Hang
authors.initials: SH
authors.lastname: Ng
authors.forename: Fu-Ming
authors.initials: FM
authors.lastname: Fang
authors.forename: Yung-Liang
authors.initials: YL
authors.lastname: Wan
authors.forename: Ming-Jang
authors.initials: MJ
authors.lastname: Hsieh
authors.forename: Po-Ping
authors.initials: PP
authors.lastname: Liu
authors.forename: Chia-Te
authors.initials: CT
authors.lastname: Kung
authors.forename: Ber-Ming
authors.initials: BM
authors.lastname: Liu
mesh_terms: D016121:Brachiocephalic Veins / Q000000981:diagnostic imaging* / Q000293:injuries*; D003287:Contrast Media; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014652:Vascular Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*
chemical_list: D003287:Contrast Media