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Case Report
 
Chest X-Ray appearance of total opacification of the hemithorax following central venous line insertion: A cautionary tale
Victor Kong1, Leah Naidoo2, Damon Jeetoo3, George Oosthuizen4, Grant Laing5, Damian Clarke5
1MBChB, Surgical Registrar, Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, Edendale Hospital, Pietermaritzburg, KwaZulu Natal, South Africa.
2MBChB, Surgical House Officer, Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, Edendale Hospital, Pietermaritzburg, KwaZulu Natal, South Africa.
3MBChB, Radiology Registrar, Department of Radiology, Edendale Hospital, Pietermaritzburg, KwaZulu Natal, South Africa.
4FCS(SA), Senior Consultant Trauma Surgeon, Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, Edendale Hospital, Pietermaritzburg, KwaZulu Natal, South Africa.
5FCS(SA), Consultant Trauma Surgeon, Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, Edendale Hospital, Pietermaritzburg, KwaZulu Natal, South Africa

doi:10.5348/ijcri-2013-12-411-CR-5

Address correspondence to:
Dr Victor Kong
Department of General Surgery
Edendale Hospital, Edendale Main Road
Pietermaritzburg, 3200
South Africa
Email: victorywkong@yahoo.com

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How to cite this article:
Kong V, Naidoo L, Jeetoo D, Oosthuizen G, Laing G, Clarke D. Chest X-Ray appearance of total opacification of the hemithorax following central venous line insertion: A cautionary tale. International Journal of Case Reports and Images 2013;4(12):686–690.


Abstract
Introduction: Central venous line insertion is associated with significant complications. Procedural complications relating to lung injury is relatively common, and these may require tube thoracostomy for management. Although a post-procedure chest X-ray is routinely undertaken in many centers, erroneous interpretation can lead to potentially incorrect and unnecessary further intervention.
Case Report: We report a case of a 25-year-old male who had a central venous line inserted, with the Chest X-ray appearance of a massive opacification of the hemithorax misdiagnosed as a hemothorax and planned tube thoracostomy. It was subsequently confirmed as a complete pulmonary collapse caused by a large mucus plug with obstruction of the main bronchus. This completely resolved after an awake flexible bronchoscopic clearance, without the need for tube thoracostomy.
Conclusion: Whilst Chest X-ray allows identification of most mechanical complications of central venous line insertion, accurate interpretation and correct clinical correlation are absolutely critical in order to avoid unnecessary interventions.

Keywords: Central venous line, Hemothorax


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Author Contributions
Victor Kong – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Leah Naidoo – Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Damon Jeetoo – Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
George Oosthuizen – Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Grant Laing – Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Damian Clarke – Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
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Conflict of interest
Authors declare no conflict of interest.
Copyright
© Victor Kong et al. 2013; This article is distributed the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any means provided the original authors and original publisher are properly credited. (Please see Copyright Policy for more information.)