Hydrothorax caused by catheter malposition misdiagnosed via using plain radiography

Abstract

We report the case of a child with hydrothorax caused by the misidentification of catheter malposition using plain radiography. A 9-month-old girl underwent central venous catheterization via the right subclavian vein. Catheter tip was evaluated mistakenly as in the right atrium by plain radiography. The catheter was retracted 2 cm and 1/3 normal saline infusion was initiated at 15 ml/hr. The patient became hypoxemic at the 20th hour of fluid infusion. On radiography, the right lung was completely opaque and the catheter tip was positioned in the right lung. Bedside sonography revealed a massive pleural effusion in the right lung and the catheter tip in the right pleural space. The catheter was removed and the pleural effusion was drained via chest tube. The location of the catheter tip should be determined by an accurate technique before infusing fluid. Plain radiography can be misleading for the detection of malposition.