Iatrogene hydrothorax na accidentele injectie van jodiumhoudende contrastvloeistof in de pleuraholte via een pigtailkatheter

Abstract

Iatrogenic hydrothorax after accidental injection of iodine contrast medium into the thorax cavity via a pigtail catheter This article describes the case of a 33-year-old man with a spontaneous pneumothorax. Because of the oncological history of the patient, a CT-scan of the thorax was performed to exclude a malignant origin. Accidentally, the iodine contrast suspension was instilled directly into the pleural cavity through a pigtail catheter, placed to treat the pneumothorax. Watchful waiting and intensive monitoring were preferred after multidisciplinary counselling. 300 cc of citrine pleural fluid, low in cells, was drained and labelled as reactive. No direct or long-term complications were found during the first year of the follow-up. To the knowledge of the authors, no similar incident was ever published in scientific literature before. Annually, more than 2 million CT-scans are performed in Belgium. In at least 0.14% of all procedures using contrast media, there is extravasation. In 2022, the guidelines on the prevention and treatment of contrast extravasation were updated. Although spontaneous resolution is expected, anaphylaxis, surinfection and tissue necrosis are severe and possible complications. Despite the fact that different strategies exist, there is little evidence or consensus on the best approach. The complicated course of this case led to a prolonged hospitalization as well as increased costs for the patient, the hospital and the society. Severe possible factors contributing to erroneous medication or contrast solution administration are discussed. It remains of the utmost importance that healthcare professionals critically reflect on all their decisions, however common they may seem. Doing so, they can learn from their mistakes and ameliorate the complex healthcare processes of tomorrow.