This case represents an unusual scenario of late bleeding and hematoma caused by elevated central venous pressures that resulted from a Valsalva type maneuver with subsequent disruption of the normal clotting mechanism and bleeding. Although it is not known what pressures are required to result in such an event, patients should be instructed to avoid heavy lifting and strenuous activities for at least 1 week to minimize this occurrence.
The patient provided consent for the use of her images and there are no patient identifiers in the images used.
Dr. Nahabedian is a consultant for LifeCell. The remaining authors have no financial interests or commercial associations to disclose. No funding was received for this study.
Christopher Fleury, B.S.
Naveen M. Krishnan, M.D., M.Phil.
Kevin D. Han, M.D.
Maurice Y. Nahabedian, M.D.
1. Guth AARoutine chest X-rays after insertion of implantable long-term venous catheters: Necessary or not?Am Surg20016726–29
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