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British Journal of Anaesthesia, 2002, Vol. 88, No. 2 298-300
© 2002 The Board of Management and Trustees of the British Journal of Anaesthesia

Case Reports

Infected mediastinitis secondary to perforation of superior vena cava by a central venous catheter

P. Valat*,1, C. Pellerin1, O. Cantini1, J. Jougon2, F. Delcambre2, P. Morales3 and G. Janvier1

1Service d’Anesthésie-Réanimation Chirurgicale II, 2Service de Chirurgie Thoracique and 3Service de Radiologie, Centre Médico-Chirurgical de la Maison du Haut-Lévêque, Groupe Hospitalier Sud, Avenue de Magellan, F-33604 Pessac CEDEX, France*Corresponding author

We describe the first case of infected mediastinitis associated with central venous catheter insertion. The rare occurrence of this complication may be explained by the fact that it results from central venous catheter-related bloodstream infection and catheter perforation of superior vena cava. The symptoms of this complication (chest pain, dyspnoea) are not specific. Diagnosis should be confirmed by chest x-ray and computerized tomography which show hydromediastinum and pleural effusion. Removal and subsequent culture of the catheter tip will confirm infection. Appropriate antibiotic therapy, guided by sensitivities of the cultured organisms, should be commenced. Any pleural effusion should be drained by thoracocentesis, and the pleural fluid cultured. In case of fever, bacteraemia or shock, a thoracotomy to drain mediastinal and pleural effusions may be considered.

Br J Anaesth 2002; 88: 298–300


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