Acute obstruction of craniocervical venous drainage in a lung-transplant patient.

Abstract

CENTRAL VENOUS CATHETER (CVC)-related thrombosis is a well-described complication. Although most patients with CVC-related thrombosis remain asymptomatic, 1 acute obstruction of craniocervical drainage is potentially life-threatening.2 and 3 This report describes a rare case of a patient with severe craniofacial congestion during staged chest closure 4 days after bilateral lung transplantation. Vascular studies revealed a massive thrombosis of the right internal jugular vein (IJV) and chronic obstruction of the innominate vein, possibly related to the CVC. The potential effect of acute obstruction of the IJV system on clinical outcome and the importance of confirming the patency of craniocervical venous drainage when selecting pulmonary artery catheter (PAC) and CVC insertion sites, especially in patients with a history of CVC placement, are discussed.