Iatrogenic Recurrent Pneumothorax

Introduction: Tunneled central venous catheters, via left internal jugular vein, are essential for long-term use. However, rare complications can arise from misplacement, including pneumothorax. Case Description: 53 yo M, with 3 left-sided pneumothoraces following placement of a tunneled left IJ catheter. Despite repeated chest tube placements, the pneumothorax recurred. CT imaging could not definitively determine the position of the catheter tip, though possibilities included the azygos vein, a small left thoracic vein, or entry into the pleural space. The suspicion remained high that the catheter was malpositioned into an anomalous venous structure adjacent to the left side of the heart. Definitive resolution of the pneumothorax was achieved only after removal of the tunneled catheter. Follow-up chest X-rays confirmed complete resolution of the pneumothorax without further intervention. Discussion: This rare complication of left IJ tunneled catheter placement with recurrent pneumothorax resistant to chest tube management suggests abnormal catheter trajectory. Misplacement into annonymous abnormal vein, though uncommon, must be considered when standard imaging fails to clearly identify catheter tip position. Clinicians should maintain a high index of suspicion and consider early catheter removal when clinical and radiologic findings suggest malposition.