Respiratory arrest due to hematoma caused by thyreocervical trunk branch laceration and confluence of sinuses perforation.
BACKGROUND
Central venous catheterization plays an important role in the treatment of emergency patients who require renal replacement therapy. Emergency patients with end-stage renal disease are at high risk for development of complications because of coagulation disorders, tissue, and organ changes due to uremia, anatomic variations, and obstruction of the large central veins. Complications associated with catheter placement can be mechanical, infectious, and thrombotic, and may occur during or following insertion of central venous catheterization which is a life-saving procedure for patients.


METHODS
We report a case of respiratory arrest in a 76-year-old woman suffering from end-stage renal disease for 14 years, because of large soft tissue subcutaneous hematoma in the right upper thoracic outlet. The rapid development of hematoma was a consequence of arterial bleeding from the branch of the thyreocervical trunk. Laceration of the thyreocervical trunk branch during central venous catheterization is a rare complication. Later diagnostic images revealed catheter perforation of confluence of sinuses which also complicated this case. We briefly discuss signs, symptoms, and management of the patient.


CONCLUSIONS
Although arterial puncture of the carotid artery during the Seldinger technique is well-known life-threatening complication which can be recognized by light red pulsatile blood during aspiration, smaller arteries such as the thyreocervical trunk branch can be punctured during the procedure and lead to serious complications.
Department of Anesthesiology, Reanimatology and Intensive care, University Hospital Center Zagreb, Croatia. sanja.sakan@hotmail.com
Sanja
S
Sakan
Robert
R
Baronica
Nikolina
N
Basic-Jukic
Ranka
R
Stern-Padovan
Dinko
D
Tonkovic
D000208:Acute Disease; D000368:Aged; D015901:Angiography, Digital Subtraction; D001158:Arteries / Q000293:injuries; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D003392:Cranial Sinuses / Q000000981:diagnostic imaging / Q000293:injuries*; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D022125:Lacerations / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D061330:Multidetector Computed Tomography; D006435:Renal Dialysis; D012131:Respiratory Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D057772:Vascular System Injuries / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy