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Published on: January 13, 2026
Left brachiocephalic vein perforation: computed tomographic features and treatment considerations
Sheung-Fat Ko1, Shu-Hang Ng, Fu-Ming Fang
1Department of Radiology, College of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University, Kaohsiung 833, Taiwan. sfatko@adm.cgmh.org.tw
Left brachiocephalic vein perforation (LBCVP) diagnosis is aided by CT scans. Stable cases with small hematomas can be managed conservatively, while unstable cases require surgery.
Area of Science:
- Vascular Surgery
- Diagnostic Imaging
- Thoracic Medicine
Background:
- Left brachiocephalic vein perforation (LBCVP) is a rare but serious condition.
- Clinical presentation often includes acute chest pain and widened mediastinum.
Purpose of the Study:
- To detail the clinical and computed tomographic (CT) findings in five LBCVP cases.
- To evaluate diagnostic and management strategies for LBCVP.
Main Methods:
- Retrospective review of clinical data and imaging features of 5 LBCVP patients.
- Analysis of CT scans for characteristic LBCVP signs.
Main Results:
- Common etiologies include central catheterization and trauma.
- CT revealed cord-like hematoma along the left brachiocephalic vein and anterior mediastinal hematoma (AMH).
- Conservative management was successful for stable patients with AMH < 5 cm; surgery was required for unstable patients with AMH > 7 cm.
Conclusions:
- CT is instrumental in diagnosing LBCVP.
- Conservative management is suitable for stable LBCVP with small AMH.
- Prompt surgical intervention is crucial for unstable LBCVP patients.
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