Kono Hiroki, Shako Daiki, Sato Yoshimi, Kawasaki Tatsuya
Department of Cardiology, Matsushita Memorial Hospital, Moriguchi, Osaka, Japan.
J Med Cases. 2022 Jun;13(6):253-256. doi: 10.14740/jmc3811. Epub 2022 Jun 11.
Thoracic duct injury is a rare mechanical complication during the insertion of a central venous cannula via the left internal jugular vein. We report a case of thoracic duct injury during the insertion of a temporary pacing lead via the right internal jugular vein. A 92-year-old woman presented with third-degree atrioventricular block. Temporary ventricular pacing was attempted via the right internal jugular venous route, but a guidewire and sheath migrated into the vessel structure that was not directly connected to the right ventricle. Considering the characteristics of the fluid obtained from the vessel and the anatomical components of the mediastinum, a diagnosis of thoracic duct injury was made. The system inserted incorrectly was removed and a pacing lead was placed in the right ventricular apex through the right internal jugular vein. Her clinical course was uneventful without developing pneumothorax, hemothorax, or chylothorax, and 5 days later, a permanent pacemaker was implanted via the left subclavian venous route.
胸导管损伤是经左颈内静脉插入中心静脉导管时罕见的机械性并发症。我们报告1例经右颈内静脉插入临时起搏导线时发生胸导管损伤的病例。一名92岁女性出现三度房室传导阻滞。尝试经右颈内静脉途径进行临时心室起搏，但导丝和鞘管移入了未直接与右心室相连的血管结构。根据从血管中获取的液体特征和纵隔的解剖结构，诊断为胸导管损伤。将误插入的系统取出，经右颈内静脉在右心室尖部置入起搏导线。她的临床过程平稳，未发生气胸、血胸或乳糜胸，5天后经左锁骨下静脉途径植入了永久性起搏器。
