Sudden hypotension occurring after 4 days of left-sided central catheter placement

Central venous catheters (CVCs) have an important role in the management of critically ill patients. In contrast to the immediate complications after CVC insertion, the late complications were difficult to be noticed without high suspicion despite their life-threatening outcome. We report a rare but fatal delayed vascular perforation occurring after 4 days of left-sided hemodialysis catheter insertion. A 74-year-old male with septic shock was treated with continuous renal replacement therapy (CRRT) and recovered smoothly during hospitalization. Refractory hypotension occurred abruptly on the fourth hospital day. Chest X-ray and computed tomography revealed that the catheter tip perforated the innominate vein and located the mediastinum. He finally died despite the emergent radiologic intervention.