Difficulty during pulmonary arterial catheterization caused by retrosternal thyroid gland

Catheterization of the central vein is commonly attempted to obtain central venous access for hemodynamic monitoring, management and administration of fluids in some surgical procedures [1]. Pulmonary arterial catheterization (PAC) is a central catheterization technique and an important part of the management of cardiac surgical procedures, accepted for treating patients with shock states. Complications from PAC may be classified into 2 main categories: technical problems and misinterpretation of data. The technical complications are difficulties of establishing central venous access, complications of the catheterization procedure, and complications of the catheter residence [2]. Complications that result from patient characteristics, for example anatomical variations, are important factors to experience difficulty in central venous access. Principally, after the insertion of central venous catheters, chest radiographs are obtained to ensure correct positioning of the catheter tip in the superior vena cava and to exclude mechanical complications, such as pneumothorax. The presented case had a big retrosternal thyroidal mass, which led to anatomical variations in main vascular structures, and caused difficulty in central venous access and PAC.