Left brachiocephalic vein perforation: computed tomographic features and treatment considerations.
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.
Ko
Sheung-Fat
SF
Department of Radiology, College of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University, Kaohsiung 833, Taiwan. sfatko@adm.cgmh.org.tw
Ng
Shu-Hang
SH
Fang
Fu-Ming
FM
Wan
Yung-Liang
YL
Hsieh
Ming-Jang
MJ
Liu
Po-Ping
PP
Kung
Chia-Te
CT
Liu
Ber-Ming
BM
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*
D003287:Contrast Media