Left brachiocephalic vein perforation: computed tomographic features and treatment considerations

Ko, Sheung-Fat; Ng, Shu-Hang; Fang, Fu-Ming; Wan, Yung-Liang; Hsieh, Ming-Jang; Liu, Po-Ping; Kung, Chia-Te; Liu, Ber-Ming

doi:10.1016/j.ajem.2007.06.013

« Previous Next »American Journal of Emergency Medicine
Volume 25, Issue 9 , Pages 1051-1056, November 2007

Left brachiocephalic vein perforation: computed tomographic features and treatment considerations

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

Received 22 May 2007; received in revised form 11 June 2007; accepted 13 June 2007.

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.