Emphysematous thrombophlebitis caused by a misplaced central venous catheter: A case report  

作　　者：Ni Chen Hua-Jun Chen Tao Chen Wen Zhang Xiao-Yun Fu Zhou-Xiong Xing 

机构地区：[1]Department of Critical Care Medicine,The Affiliated Hospital of Zunyi Medical University,Zunyi 563000,Guizhou Province,China [2]Department of Critical Care Medicine,Kweichow Moutai Hospital,Renhuai 564500,Guizhou Province,China

出　　处：《World Journal of Clinical Cases》2023年第29期7207-7213,共7页世界临床病例杂志

基　　金：Supported by Foundation of Guizhou Science and Technology Department,No.QIANKEHEZHICHEN[2022]YIBAN179;Foundation of Kweichow Moutai Hospital,No.MTyk2022-12;Foundation of Department of Health of Guizhou Province,No.gzwkj2021-036;Guizhou Education Department,No.QIANJIAOHEKYZI[2018]239.

摘　　要：BACKGROUND Central venous catheters(CVCs)often cause life-threatening complications,especially CVC-related bloodstream infection(CVC-BSI)and catheter-related thrombosis(CRT).Here,we report an unusual case of misplaced CVC-induced emphysematous thrombophlebitis,a rare but potentially lethal form of CRT and CVC-BSI characterized by both thrombosis and gas formation.CASE SUMMARY A 48-year-old male presented to the emergency room of a local hospital with sudden-onset headache and coma for 4 h.Computed tomography(CT)revealed right basal ganglia hemorrhage,so emergency decompressive craniotomy was performed and a CVC was inserted through the right subclavian vein for fluid resuscitation during anesthesia.Two days later,the patient was transferred to the intensive care unit of our hospital for further critical care.On day 9 after CVC insertion,the patient suddenly developed fever and hypotension.Point-of-care ultrasound(POCUS)demonstrated thrombosis and dilatation of the right internal jugular vein(IJV)filled with thrombosis.Ultrasonography also revealed that the CVC tip had been misplaced into the IJV and was surrounded by gas bubbles,which manifested as hyperechoic lines with dirty shadowing and comet-tail artifacts.Further CT scan confirmed air bubbles surrounding the CVC in the right neck.The final diagnosis was septic emphysematous thrombophlebitis induced by a misplaced CVC and ensuing septic shock.The responsible CVC was removed immediately.The patient received fluid resuscitation,intravenous noradrenaline,and a 10-d ultra-broad spectrum antibiotic treatment to combat septic shock.Both CVC and peripheral venous blood cultures yielded methicillin-resistant Staphylococcus cohnii.The patient was gradually weaned off vasopressors and the symptoms of redness and swelling in the right neck subsided within 7 d.CONCLUSION Emphysematous thrombophlebitis is a fulminant and life-threatening CVC-BSI associated with thrombosis and gas formation in the vein.A misplaced CVC may facilitate the development of emphysematous thromb

关 键 词：Emphysematous thrombophlebitis Septic thrombophlebitis Central venous catheter ULTRASOUND Catheter-related thrombosis Central venous catheter-related bloodstream infection Case report 

分 类 号：R654.2[医药卫生—外科学]