Derrame pleural unilateral tras perforación vascular por catéter venoso central de inserción periférica: utilidad del verde de indocianina en el diagnóstico / Unilateral pleural effusion caused by vessel perforation due to peripherally inserted central catheter: Indocyanine green as a diagnostic tool

Varón de 44 años con desnutrición calórico-proteica grave en el contexto de una estenosis pilórica benigna, a quien se decidió colocar un catéter central de inserción periférica (CCIP) para tratamiento con nutrición parenteral. Al quinto día de la inserción del catéter, presentó un derrame pleural derecho masivo de color blanco e insuficiencia respiratoria tras la realización de una endoscopia digestiva alta para el tratamiento de la estenosis pilórica. Ante la sospecha inicial de quilotórax el paciente ingresó en la Unidad de Reanimación. Se administró verde de indocianina a través del CCIP, obteniendo a los 30 min una coloración verdosa del contenido del derrame pleural; este resultado nos hizo sospechar que el derrame pleural era secundario a una perforación vascular por el CCIP con extravasación de la nutrición parenteral al espacio pleural. Se realizó una tomografía computarizada toracoabdominal, que confirmó la existencia de una perforación a nivel de la vena innominada. La colocación de un CCIP puede asociarse a complicaciones graves, como la perforación de una vena central, por tanto, la correcta posición de un catéter central debe ser siempre comprobada. La prueba diagnóstica de elección de perforación vascular a nivel central es la tomografía computarizada con contraste; sin embargo, ante la existencia de derrame pleural en este contexto, es posible emplear un colorante que, administrado de forma intravenosa, oriente su diagnóstico in situ. En este caso se empleó el verde de indocianina con este objetivo (AU)

A peripherally inserted central catheter (PICC) was inserted into a 44-year-old man to provide parenteral nutrition in a protein-calorie malnutrition secondary to a benign pyloric stenosis. On the fifth day while monitoring the catheter, the patient presented with a massive whitish pleural effusion after undergoing gastric endoscopy in order to treat pyloric stenosis. Chylothorax was initially suspected, and the patient was admitted to a recovery unit. Indocyanine green was administered through the PICC, obtaining a greenish discoloration in the pleural effusion 30 min later. This led to the diagnosis of a pleural effusion caused by a vessel perforation due to the PICC, leading to parenteral nutrition extravasation. Thoraco-abdominal computed tomography was performed, which confirmed an innominate vein perforation due to the PICC. PICC insertion may be associated with severe complications, such as central vessel perforation, and therefore the correct position of a central catheter should be always checked. Intravenous computed tomography contrast is the gold standard for central vascular perforation diagnosis. However if a pleural effusion occurs in this context, it is possible to use a dye, which administered intravenously can lead us to the correct diagnosis in situ. Indocyanine green was used for this purpose in this case (AU)

[Unilateral pleural effusion caused by vessel perforation due to peripherally inserted central catheter: Indocyanine green as a diagnostic tool]. / Derrame pleural unilateral tras perforación vascular por catéter venoso central de inserción periférica: utilidad del verde de indocianina en el diagnóstico.

A peripherally inserted central catheter (PICC) was inserted into a 44-year-old man to provide parenteral nutrition in a protein-calorie malnutrition secondary to a benign pyloric stenosis. On the fifth day while monitoring the catheter, the patient presented with a massive whitish pleural effusion after undergoing gastric endoscopy in order to treat pyloric stenosis. Chylothorax was initially suspected, and the patient was admitted to a recovery unit. Indocyanine green was administered through the PICC, obtaining a greenish discoloration in the pleural effusion 30 min later. This led to the diagnosis of a pleural effusion caused by a vessel perforation due to the PICC, leading to parenteral nutrition extravasation. Thoraco-abdominal computed tomography was performed, which confirmed an innominate vein perforation due to the PICC. PICC insertion may be associated with severe complications, such as central vessel perforation, and therefore the correct position of a central catheter should be always checked. Intravenous computed tomography contrast is the gold standard for central vascular perforation diagnosis. However if a pleural effusion occurs in this context, it is possible to use a dye, which administered intravenously can lead us to the correct diagnosis in situ. Indocyanine green was used for this purpose in this case.