Left brachiocephalic vein perforation: computed tomographic features and treatment considerations - 09/08/11

Doi : 10.1016/j.ajem.2007.06.013

Sheung-Fat Ko, MD ^a,^⁎ , Shu-Hang Ng, MD ^a, Fu-Ming Fang, MD ^a, Yung-Liang Wan, MD ^a, Ming-Jang Hsieh, MD ^b, Po-Ping Liu, MD ^c, Chia-Te Kung, MD ^d, Ber-Ming Liu, MD ^d
^a Department of Radiology, College of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University, Kaohsiung 833, Taiwan
^b Department of Cardiovascular and Thoracic Surgery, College of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University, Kaohsiung 833, Taiwan
^c Department of Traumatology, College of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University, Kaohsiung 833, Taiwan
^d Department of Emergency Medicine, College of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University, Kaohsiung 833, Taiwan

^⁎Corresponding author.

Abstract

Objective

To report the clinical and computed tomographic findings of 5 cases of left brachiocephalic vein perforation (LBCVP).

Methods

The clinical and imaging features of 5 patients with LBCVP (1 woman, 4 men; mean age, 57.6 years) encountered over the last 2 decades were reviewed.

Results

Etiologies included left jugular central catheter penetration in 2 patients, blunt trauma in 2, and idiopathic in 1. All patients manifested acute chest pain with a widened mediastinum on chest radiographs. Characteristic computed tomographic features included a cord-like hematoma along the course of the left brachiocephalic vein associated with a left upper anterior mediastinal hematoma (AMH). Three clinically stable patients with AMH smaller than 5 cm convalesced after conservative treatment and 2 clinically unstable patients with AMH bigger than 7 cm recovered well after surgery.

Conclusions

Computed tomography is helpful in diagnosing LBCVP. Under close surveillance, patients with stable LBCVP with AMH smaller than 5 cm may be managed conservatively. However, emergency surgery is warranted if there are any signs of instability.

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Plan

Surgical findings, treatment outcome, and follow-up

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Vol 25 - N° 9

P. 1051-1056 - novembre 2007 Retour au numéro

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Left brachiocephalic vein perforation: computed tomographic features and treatment considerations - 09/08/11

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