Hôpitaux Universitaires de Strasbourg - Hôpital de Hautepierre, Intensive Care Unit, Strasbourg, France.
J Int Med Res. 2024 Oct;52(10):3000605241281665. doi: 10.1177/03000605241281665.
Mechanical complications during central catheterisation occur in approximately 15% of cases. This report describes a potentially fatal yet avoidable complication and highlights the typical radiological features of a retropharyngeal haematoma.A patient with acute myeloid leukaemia was admitted to the intensive care unit with respiratory distress immediately after an attempt to insert a subclavian catheter without ultrasound guidance. A computed tomography scan revealed nearly complete obstruction of the upper airway by a retropharyngeal haematoma, with a blush of contrast agent. There was also a mass effect on the trachea and mediastinal structures. The haematoma was caused by accidental puncture of the thyrocervical artery. The patient's condition improved following orotracheal intubation, transfusion of platelets and fresh frozen plasma, arterial radio-embolisation, and clinical monitoring of haematoma resorption, which restored airway patency.A retropharyngeal haematoma is a potentially lethal complication, and its treatment carries significant risks. Therefore, central catheter insertion should likely not be attempted without ultrasound guidance to avoid serious complications for patients.
在中心置管过程中，机械并发症的发生率约为 15%。本报告描述了一种潜在致命但可避免的并发症，并强调了咽后血肿的典型放射学特征。一名急性髓系白血病患者在尝试在没有超声引导的情况下插入锁骨下导管后立即因呼吸困难被收入重症监护病房。计算机断层扫描显示，咽后血肿几乎完全阻塞了上呼吸道，造影剂呈“红晕”。气管和纵隔结构也受到了肿块效应的影响。血肿是由于颈袢动脉意外穿刺所致。患者在经口气管插管、输注血小板和新鲜冷冻血浆、动脉放射性栓塞以及血肿吸收的临床监测后病情好转，恢复了气道通畅。咽后血肿是一种潜在致命的并发症，其治疗存在重大风险。因此，为避免患者出现严重并发症，中心置管不应在没有超声引导的情况下进行。
