Johnathan Ngo1, Ananthakrishnapuram Aravindan1, Jeffrey Wong1
1Liverpool Hospital, Liverpool, Australia
Biography:
Dr Johnathan Ngo is a recently fellowed Nephrologist and the current Transplant Fellow at Liverpool hospital. His special interests include general nephrology, renal transplantation, health informatics and data analytics. He is actively involved in the provision of medical education.
Background:
Vascular access is a lifeline for patients requiring haemodialysis. Vascaths are frequently inserted into the internal jugular vein, especially in the acute setting. Identification of adjacent structures and guidance with ultrasound may reduce potential complications such as pneumothoraces and inadvertent arterial puncture.
Case Presentation:
We describe a case of a 67-year-old female with a history of stage IV chronic kidney disease from lupus nephritis, who presented with haemorrhagic shock following cryoablation for a right lower pole renal cell carcinoma, requiring interventional radiology-guided embolisation. She sustained a multifactorial acute kidney injury necessitating the commencement of haemodialysis. During the insertion of a tunnelled vascath, a right-sided thyroid cyst was inadvertently punctured as it mimicked the internal jugular vein. The second attempt resulted in successful placement in the right internal jugular vein. There were no significant clinical consequences of this event, and a formal neck ultrasound demonstrated multinodular goitre with numerous bilateral cysts. One right-sided thyroid cyst had small-volume haemorrhage consistent with the inadvertent puncture.
Conclusion:
This rare case of unintentional thyroid cyst puncture illustrates the importance of identifying all anatomical structures due to their proximity and potential for mimicry.