BILATERAL HYDROTHORAX CAUSED BY LEFT EXTERNAL JUGULAR VENOUS CATHETERPERFORATION

We report a case of bilateral hydrothorax secondary to perforation of the superior vena caval wall, which was caused by a double-lumen centr al venous catheter used for catheterization of the left jugular vein. A patient undergoing craniectomy developed a right pleural effusion fo llowed by a left hydrothorax 12 hours after the operation. There are s everal possible explanations for this phenomenon. The horizontal cours e of the left brachiocephalic vein, heart contraction, mechanical vent ilation, changes in patient position, and solutions of high osmolality can promote vascular erosion by the catheter tip. High hydrostatic pr essure in the thorax associated with a congenital or an acquired inter pleural communication may cause bilateral hydrothorax. We suggest that it is always preferable to cannulate a central vein through the right side. When the left external jugular vein has to be cannulated, an in travascular ECG may be helpful to determine the position of the cathet er tip. Chest roentgenogram should be obtained early to confirm cathet er position. Furthermore, the distal port of the double-lumen central venous catheter should be used perioperatively for continuous surveill ance of the central venous pressure waveform to ensure early warning o f venous perforation.