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Pneumothorax following central venous catheterisation?
  1. R J Parker,
  2. C G Wathen
  1. Department of Respiratory Medicine, Wycombe Hospital, High Wycombe, Buckinghamshire, UK
  1. Correspondence to:
 Dr R J Parker
 Thoracic Medicine Office, Wycombe Hospital, High Wycombe, Buckinghamshire HP11 2TT, UK; robertparkerdoctors.org.uk

Abstract

A chest radiograph performed to check the position of a central venous catheter in a patient appeared to show a pneumothorax. Intercostal drain insertion was prepared. Reassessment of the patient and a further radiograph confirmed that the "pneumothorax" was an artefact from a prominent skin fold due to the patient’s body habitus.

  • Central venous catheters
  • pneumothorax

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A 73 year old woman with sepsis and renal impairment had a right subclavian central venous catheter placed as part of fluid resuscitation. The procedure was performed by an experienced operator. It was achieved "first pass" and thought to be uncomplicated. A supine chest radiograph performed to check position appeared to demonstrate a right sided pneumothorax (fig 1A). An intercostal drain was considered. The patient’s body mass index was >30 kg/m2, respiratory rate 18 breaths/min and oxygen saturation 96% in room air. She was comfortable, speaking full sentences, and respiratory examination was unremarkable. The chest radiograph was re-evaluated. The pneumothorax is not so clear at the apex, and lung markings can be seen to the lung edge. A repeat erect chest radiograph (fig 1B) did not show the pneumothorax. We concluded that the abnormality is an artefact from a prominent skin fold due to the patient’s habitus.

Figure 1

  (A) Chest radiograph performed supine after central venous catheterisation; (B) erect radiograph showing the disappearance of the apparent pneumothorax.

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Footnotes

  • Competing interests: there are no competing interests

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