Clinical Snapshot
Intraesophageal Malposition of a Subclavian Catheter
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A very elderly man had an accident while riding his bicycle and was run over and trapped by a car. During emergency room treatment, a large-bore catheter was placed in the right subclavian vein using the landmark approach; although advancement was uncomplicated, aspiration was not possible. Computed tomography showed the course of the catheter dorsal to the trachea where the catheter had perforated the esophagus, with the distal 8 cm of the catheter protruding into the esophagus (arrows on Figure). The catheter was removed, and in order to prevent mediastinitis, an intraesophageal open-pore film drainage was placed for endoscopic negative pressure therapy, and antibiotic treatment was initiated. Malposition of central venous catheters is not uncommon, with arterial, intrapleural, and mediastinal malpositions occurring most frequently. Catheter malposition in the esophagus following subclavian vein puncture is an absolute rarity. However, perforation of a hollow organ that is always colonized by microbes carries the risk of potentially serious complications such as mediastinitis, sepsis, scarring (stricture), and esophagotracheal fistula. The further course of the present case was uncomplicated.
Acknowledgments: Radiological images and findings provided by the Klinik für Radiologie und Neuroradiologie der Kliniken Maria Hilf GmbH Mönchengladbach, Germany, Prof. Dr. med. Adrian Ringelstein.
Dr. med. Andreas Schneider, Klinik für Anästhesiologie und Operative Intensivmedizin, Kliniken Maria Hilf GmbH Mönchengladbach, andreas.schneider@mariahilf.de
Prof. Dr. med. Sebastian Bergrath, Zentrum für Klinische Akut- und Notfallmedizin, Kliniken Maria Hilf GmbH Mönchengladbach
Prof. Dr. med. Andreas Kirschniak, Klinik für Allgemein- und Viszeralchirurgie, Kliniken Maria Hilf GmbH Mönchengladbach
Conflict of interest statement: The authors state that no conflict of interest exists.
Translated from the original German by Christine Rye.
Cite this as: Schneider A, Bergrath S, Kirschniak A: Intraesophageal malposition of a subclavian catheter. Dtsch Arztebl Int 2024; 121: 839. DOI: 10.3238/arztebl.m2024.0192
