Delayed innominate vein perforation and massive hemothorax following left-sided PICC placement: A case report.
Yong-Hwan Cho, Jin-Heon Jeong
✦ AI-curated · Sources linked
Case in brief
An 82-year-old woman with acute ischemic stroke had a peripherally inserted central catheter (PICC) placed in her left arm. Initial chest radiographs showed an abnormal catheter position, which was misinterpreted as improved on follow-up. Five days later, she developed a massive right-sided pleural effusion due to delayed perforation of the innominate vein. Urgent chest tube insertion and surgical repair were performed, leading to her recovery and discharge in stable condition.
What made this case unusual
The case illustrates a diagnostic paradox where the resolution of catheter tortuosity was mistakenly viewed as a positive outcome, masking the underlying complication of vascular perforation.
Diagnostic / clinical pearl
Clinicians should exercise caution when interpreting changes in catheter position on radiographs, as apparent improvements may conceal serious complications like vascular perforation.
Why it matters
This case underscores the need for thorough evaluation of radiographic findings and the importance of functional assessments in patients with central venous access devices.