Pneumothorax discovered following central venous catheter placement for apheresis

A 14-year-old female with B-cell acute lymphoblastic leukemia presented to apheresis clinic for apheresis stem cell collection (HPC(A)) 1 day after high-flow central venous catheter (CVC) placement. A left-sided approach was originally attempted under ultrasound guidance, but was unsuccessful, resulting in a right internal jugular CVC placement with fluoroscopy confirmation. In clinic, she complained of poor sleep, abdominal pain, and rib cage pain. Physical examination revealed minimal air entry in the left lung fields with extension of the right shoulder, tachypnea, but with normal oxygen saturation (96%–100%) on room air. Chest x-ray (CXR) and pain medication were ordered, which relieved some of the pain and collection commenced. During the course of HPC(A), the patient became persistently more uncomfortable and CXR results revealed tension pneumothorax (Figure 1). She was transferred to the intensive care unit where a chest tube was placed (Figure 2), which showed improvement of the pneumothorax. Due to clinical improvement and hemodynamic stability, she had a successful collection the following day. Limited reports exist on the incidence of pneumothorax related to CVCs and collections. Madero and colleagues found a 1.7% rate of pneumothorax in children undergoing HPC(A) through CVCs.1 While Meisenberg et al. found a 3.6% rate of pneumothorax and/or hemothorax, with CVCs inserted for HPC(A) in adults.2 The general incidence of pneumothorax related to CVCs in children is reported at around 0.3%–1.04% with high-flow CVCs excluded.3 This case scenario is a rare example of a serious complication of HPC(A) that should be quickly identified and addressed. The authors have disclosed no conflicts of interest. The data that support the findings of this study are available from the corresponding author upon reasonable request.