Chest X-Ray appearance of total opacification of the hemithorax following central venous line insertion: A cautionary tale

Abstract

Central venous line insertion is associated with significant complications. Procedural complications relating to lung injury is relatively common, and these may require tube thoracostomy for management. Although a post-procedure chest X-ray is routinely undertaken in many centers, erroneous interpretation can lead to potentially incorrect and unnecessary further intervention. We report a case of a 25-year-old male who had a central venous line inserted, with the Chest X-ray appearance of a massive opacification of the hemithorax misdiagnosed as a hemothorax and planned tube thoracostomy. It was subsequently confirmed as a complete pulmonary collapse caused by a large mucus plug with obstruction of the main bronchus. This completely resolved after an awake flexible bronchoscopic clearance, without the need for tube thoracostomy. Whilst Chest X-ray allows identification of most mechanical complications of central venous line insertion, accurate interpretation and correct clinical correlation are absolutely critical in order to avoid unnecessary interventions.