We present a case of occult
hemothorax, a rare but dangerous complication resulting from cannulation of the
internal jugular vein. To date we are not aware of any case reports of bleeding
sequelae resulting from direct parenchymal lung injury. The insidious nature of
this complication, in which the clinical presentation occurred several hours
after central venous cannulation, provides an important reminder for clinicians
to follow up central line placement with imaging studies. In this case, the
latent period prior to the appearance of clinical manifestations of hemorrhage
along with the patient’s subsequent acute decompensation raises questions as to
the nature of the underlying injury and mechanisms of both detection and
prevention. The patient underwent two right video-assisted thoracoscopic
surgical explorations, the first revealed ongoing venous bleeding from within
the parenchyma of the right upper lobe which was controlled by a wedge
resection. She was ultimately discharged home and, as of the time of this
writing, appears to have recovered completely, suffering no long-term sequelae
as a result of this complication.
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