title: [Unilateral pleural effusion caused by vessel perforation due to peripherally inserted central catheter: Indocyanine green as a diagnostic tool].
abstract: A peripherally inserted central catheter (PICC) was inserted into a 44-year-old man to provide parenteral nutrition in a protein-calorie malnutrition secondary to a benign pyloric stenosis. On the fifth day while monitoring the catheter, the patient presented with a massive whitish pleural effusion after undergoing gastric endoscopy in order to treat pyloric stenosis. Chylothorax was initially suspected, and the patient was admitted to a recovery unit. Indocyanine green was administered through the PICC, obtaining a greenish discoloration in the pleural effusion 30 min later. This led to the diagnosis of a pleural effusion caused by a vessel perforation due to the PICC, leading to parenteral nutrition extravasation. Thoraco-abdominal computed tomography was performed, which confirmed an innominate vein perforation due to the PICC. PICC insertion may be associated with severe complications, such as central vessel perforation, and therefore the correct position of a central catheter should be always checked. Intravenous computed tomography contrast is the gold standard for central vascular perforation diagnosis. However if a pleural effusion occurs in this context, it is possible to use a dye, which administered intravenously can lead us to the correct diagnosis in situ. Indocyanine green was used for this purpose in this case.
authors.affiliation: Departamento de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España. Electronic address: lucia.alvarezbaena@gmail.com.
authors.forename: L
authors.initials: L
authors.lastname: Álvarez-Baena
authors.affiliation: Departamento de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors.forename: P
authors.initials: P
authors.lastname: Duque
authors.affiliation: Departamento de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors.forename: R
authors.initials: R
authors.lastname: Ramos
authors.affiliation: Departamento de Cirugía General y Aparato Digestivo II, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors.forename: L
authors.initials: L
authors.lastname: Zarain Obrador
authors.affiliation: Departamento de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors.forename: L
authors.initials: L
authors.lastname: Fernández-Quero
mesh_terms: D000328:Adult; D002405:Catheterization, Central Venous / Q000009:adverse effects; D002406:Catheterization, Peripheral / Q000009:adverse effects; D006801:Humans; D007208:Indocyanine Green; D008297:Male; D010289:Parenteral Nutrition, Total / Q000009:adverse effects; D010996:Pleural Effusion / Q000209:etiology*
chemical_list: D007208:Indocyanine Green
keywords: Catéter venoso central; Central venous catheter; Indocyanine green; Nutrición parenteral; Parenteral nutrition; Perforación vascular; Verde de indocianina; Vessel perforation