Khalilalrahman Alshantti, eumothorax
A 61 years old Malay gentleman with underlying end-stage renal disease (ERSF) and hypertension was admitted for elective left permanent internal jugular catheter exchange for the continuation of dialysis. The procedure was complicated with malposition of the catheter, and traumatic mediastinal and pericardial hematoma causing cardiac tamponade. However, this was not noticed initially by the operator and was only realised post-procedure when the patient collapsed due to hemodynamically instability. Urgent CTA thorax confirmed the diagnosis. Misplaced catheter passed through the inferior wall of the left brachiocephalic vein with the tip lies in the mediastinum. The interventional radiologist performed balloon- assisted removal of the catheter. However, due to expanding cardiac tamponade and persistent bradycardia, emergent sternotomy was done for vessel repair and hematoma evacuation by the cardiothoracic surgeon. Post-operation, the patient’s condition stabilised and was monitored in surgical ICU and subsequently discharged well.