Airway Obstruction due to a Pre-vertebral Haematoma following Difficult Central Line Insertion – Implications for Ultrasound Guidance and Review of the Literature

Abstract

We describe a case of airway obstruction secondary to a large pre-vertebral cervico-mediastinal haematoma following failed attempts at insertion of an internal jugular central venous line. The need for a high index of suspicion to diagnose this injury and early aggressive intervention to manage it are outlined. The role of ultrasound guidance in preventing such a complication is reviewed, as well as other possible mechanisms of haematoma development.