Perforation into the pericardial sac of an infant: a rare complication of central venous catheter insertion.

Editor, Cardiac tamponade following insertion of a central venous (CV) catheter is a rare but recognised complication associated with a high mortality rate, that was addressed recently in a circular from the Department of Health, Social Services and Public Safety in Northern Ireland (1). We report a case of CV line perforation into the pericardium that was diagnosed early by a simple contrast study. A male neonate was born by elective Caesarean section following an antenatal diagnosis of exomphalos major. During a stormy in-patient course, a left-sided subclavian line (SCL) was inserted on day 33 of life. In the hours that followed, the patient’s left arm and face were noted to be “puffy”. The SCL was documented to be flushing easily but not bleeding back; its use was discontinued and a “linogram” contrast study requested [Fig. 1]. Contrast was seen outlining the central great vessels and the superior aspect of the pericardial sac. A follow-up chest radiograph showed layering of contrast within the pericardial sac, outlining the heart [Fig. 2]. An echocardiogram demonstrated a small pericardial effusion. Fig 1. “Linogram” study. Water-soluble contrast has been injected into the left subclavian line. The contrast extravasates from the line tip outlining the central great vessels and the superior aspect of the pericardial sac. Fig 2. Follow up chest radiograph after removal of the left subclavian line and insertion of a new right-sided internal jugular vein catheter. Contrast is seen filling the pericardial sac, outlining the heart. The infant gradually recovered from his surgeries over the next weeks and was discharged at 3 months.