Spinal epidural hematoma following removal of incorrectly placed jugular central venous catheter

Abstract

The authors report a rare case of iatrogenic spinal epidural hematoma associated with central venous catheter cannulation via the right internal jugular vein. This 59-year-old man was operated on for stomach cancer while under general anesthesia. A central venous line was inserted via the right internal jugular vein. The operation was completed uneventfully and postoperative fluid replacement was continued without interruption. On postoperative Day 2, marked swelling around the right side of his neck gradually worsened. Cervical CT demonstrated that the catheter tip of the central venous line had penetrated the jugular vein and entered the intervertebral foramen (C5–6), thereby reaching the spinal epidural space. The patient was immediately transported to the operating room and the catheter was carefully extracted under fluoroscopy. Several minutes after catheter removal, the patient complained of sudden severe back pain and over time developed mild paraparesis of both lower extremities. Urgent MR imaging of the spine revealed a large spinal epidural hematoma extending from C-1 to T-8 that was compressing the dorsal spinal cord. The patient underwent emergency surgical removal of the epidural hematoma as well as spinal cord decompression with a T1–4 laminectomy. After surgery, the patient showed full recovery of his lower-extremity motor function.