Massive Haemothorax after Right Internal Jugular Venous Catheter Placement for ESRD

1. ‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬
Massive Haemothorax after Right
Internal Jugular Venous Catheter
Placement for ESRD
Prof. Abdulsalam Y Taha
College of Medicine
University of Sulaimani
2022 1

2. The Case
 A 31-years old female patient a known
case of end stage renal disease (ESRD)
with chronic rejection of transplanted
kidney was admitted to Sulaymaniyah
Teaching Hospital, Sulaymaniyah, Region
of Kurdistan, Iraq because of shortness of
breath (SOB). She had clinical and
radiographic features of massive right
sided haemothorax. She had placement of
a central venous line (CVL) in the right
internal jugular vein (IJV) one week
earlier. 2

3. O2 supplementation for SOB
3

4. Left Brachio-cephalic AVF. The AVF was
functioning with audible bruit
4

5. Ecchymosis of the left upper arm due
to repeated venipunctures
5

6. Massive Right-Sided
Haemothorax 6

7. Right IJV Catheter in Place
7

8. CXR before Placement of R IJV
Catheter 8

9. The Case…
 Right sided chest tube drained about
2000 cc dark blood. The CXR following
chest tube placement showed collapsed
right lung and residual clotted
haemothorax. It was decided to interfere
surgically. Right thoracotomy was done
under GA. Large volume of clotted and
nonclotted haemothorax was drained. No
significant bleeder was identified and the
lung was healthy. Postoperative course
was smooth with full lung expansion.
9

10. Chest Tube Drainage
10

11. CXR after Placement of Chest Tube
11

12. Clots retrieved from the chest during
thoracotomy
12

13. Postoperative CXR
13

14. Comment
 Although CVL placement is a daily
procedure performed for many
indications including being a vascular
access for haemodialysis for ESRD, it can
have serious complications.
 Clinical and radiographic follow up of
the cases after placement of CVL is
mandatory to discover the complications
of haemothorax and interfere early.
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