Cardiac tamponade with chylopericardium in a 6-year-old boy with central venous catheter: a case report
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Cardiac tamponade (CT) is a rare but potentially lethal complication associated with central venous catheters (CVCs). We present a 6-year-old boy who developed CT after CVC insertion in the right internal jugular vein, with its tip in the inferior vena cava. Initially, he was hospitalized to a tertiary hospital with presumptive diagnoses of pneumonia and left ankle cellulitis. Three days after CVC placement, he developed CT, manifesting as recurrent episodes of hypotension and bradycardia. Once a bedside echocardiography showed CT, pericardiocentesis was performed, resulting in successful resuscitation. Pericardiocentesis revealed a milk-appearing pericardial fluid, indicating chylopericardium. The boy also underwent debridement and joint irrigation of the left ankle, which turned out to be osteomyelitis. Although CVC tips in most reported CVC-related CTs have been commonly located in the right atrium, our case featured a tip located in the inferior vena cava. Additionally, chylopericardium was likely due to the extravasation of total parenteral nutrition fluid, rather than the usual causes, such as recent thoracic surgery. Understanding the mechanisms behind chylopericardium associated with CVCs and timely pericardiocentesis is crucial for improving the outcomes.
Abstract
Cardiac tamponade (CT) is a rare but potentially lethal complication associated with central venous catheters (CVCs). We present a 6-year-old boy who developed CT after CVC insertion in the right internal jugular vein, with its tip in the inferior vena cava. Initially, he was hospitalized to a tertiary hospital with presumptive diagnoses of pneumonia and left ankle cellulitis. Three days after CVC placement, he developed CT, manifesting as recurrent episodes of hypotension and bradycardia. Once a bedside echocardiography showed CT, pericardiocentesis was performed, resulting in successful resuscitation. Pericardiocentesis revealed a milk-appearing pericardial fluid, indicating chylopericardium. The boy also underwent debridement and joint irrigation of the left ankle, which turned out to be osteomyelitis. Although CVC tips in most reported CVC-related CTs have been commonly located in the right atrium, our case featured a tip located in the inferior vena cava. Additionally, chylopericardium was likely due to the extravasation of total parenteral nutrition fluid, rather than the usual causes, such as recent thoracic surgery. Understanding the mechanisms behind chylopericardium associated with CVCs and timely pericardiocentesis is crucial for improving the outcomes.
참고문헌 (25)
- Karnauchow PN, "Cardiac tamponade from central venous catheterization", CMAJ, 135, pp.1145~1147 (1986)
- Kayashima K, "Factors affecting survival in pediatric cardiac tamponade caused by central venous catheters", J Anesth, 29, pp.944~952 (2015)
- Gupta R, "Migration of central venous catheters in neonates : a radiographic assessment", Am J Perinatol, 33, pp.600~604 (2016)
- Hou A, "Pericardial effusion", cardiac tamponade induced by peripherally inserted central catheters in very low birth weight infants : a case report and literature review, 2020, pp.8, 235~
- Zarkesh MR, "Neonatal cardiac tamponade, a life-threatening complication secondary to peripherally inserted central catheter : a case report", J Med Case Rep, 16, pp.305~ (2022)
- Azevedo AC, "Cardiac tamponade: a rare complication of central venous catheter - a clinical case report", Braz J Anesthesiol, 68, pp.104~108 (2018)
- Domino KB, "Injuries and liability related to central vascular catheters : a closed claims analysis", Anesthesiology, 100, pp.1411~1418 (2004)
- Murphy K, "Improving cardiac tamponade outcomes through less invasive interventions and earlier recognition", J Thorac Oncol, 13(10 Suppl), pp.S937~ (2018)
- Milner D, "Pediatric pericardial tamponade presenting as altered mental status", Pediatr Emerg Care, 19, pp.35~37 (2003)
- Nowlen TT, "Pericardial effusion and tamponade in infants with central catheters", Pediatrics, 110(1 Pt 1), pp.137~142 (2002)
- Bar-Joseph G, "Perforation of the heart by central venous catheters in infants : guidelines to diagnosis and management", J Pediatr Surg, 18, pp.284~287 (1983)
- Wirrell EC, "Massive pericardial effusion as a cause for sudden deterioration of a very low birthweight Infant", Am J Perinatol, 10, pp.419~423 (1993)
- Dib C, "Chylopericardium in adults : a literature review over the past decade(1996-2006)", J Thorac Cardiovasc Surg, 136, pp.650~656 (2008)
- Booth SA, "Central venous catheterization and fatal cardiac tamponade", Br J Anaesth, 87, pp.298~302 (2001)
- Messina Alvarez AA, "Iatrogenic cardiac tamponade secondary to central venous catheter placement : a literature review", Cureus, 15, pp.e37695~ (2023)
- Lee N, "Chylous pericardial tamponade in a haemodialysis patient with catheter-associated thrombosis of internal jugular and subclavian veins", Nephrol Dial Transplant, 21, pp.2650~2653 (2006)
- Smedts F, "Chylopericardium and chylothorax, resulting from a catheter to the left subclavian vein : an autopsy report", Klin Wochenschr, 67, pp.1214~1217 (1989)
- Van Veldhuizen PJ, "Chylothorax : a complication of a left subclavian vein thrombosis", Am J Clin Oncol, 19, pp.99~101 (1996)
- Kurekci E, "Chylothorax and chylopericardium : a complication of a central venous catheter", J Pediatr, 132, pp.1064~1066 (1998)
- Rajpal MN, "Chylous cardiac tamponade due to catheter-associated thrombosis of intrathoracic veins in a newborn infant", J Pediatr Surg Case Rep, 1, pp.180~182 (2013)
- Saxena P, "Bilateral chylothorax as a complication of internal jugular vein cannulation", Lung India, 32, pp.370~374 (2015)
- Lee EK, "An unexpected left hydrothorax after left internal jugular venous catheterisation for total parental nutrition and antibiotics", Ann Acad Med Singap, 35, pp.742~744 (2006)
- Paw HG, "Bilateral pleural effusions : unexpected complication after left internal jugular venous catheterization for total parenteral nutrition", Br J Anaesth, 89, pp.647~650 (2002)
- Haponiuk I, "Minimally invasive transxiphoid approach for management of pediatric cardiac tamponade-one center’s experience", Wideochir Inne Tech Maloinwazyjne, 10, pp.107~114 (2015)
- Speechly-Dick ME, "Osteomyelitis and infective endocarditis", Postgrad Med J, 70, pp.885~890 (1994)