PICC migration and perforation of internal jugular vein after neck dissection.
Federica Dusi, Luca Gazzini, Francesca Zanghi et al.
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Case in brief
A patient developed a perforation of the internal jugular vein due to migration of a peripherally inserted central catheter (PICC) shortly after undergoing neck dissection and free flap reconstruction. Surgical exploration revealed multiple lacerations, with the largest measuring 15 mm. The internal jugular vein was repaired, and the PICC was removed. The free flap remained intact, and the patient was discharged without complications.
Diagnostic / clinical pearl
Clinicians should be vigilant about the risk of PICC migration in patients post-neck dissection, especially following episodes of increased thoracic pressure, which can lead to vessel wall lacerations.
Why it matters
Regular monitoring of PICC tip position in these patients can help identify malpositions early, potentially preventing serious complications such as hematomas.