Pinch off syndrome

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Pinch-off syndrome is a spontaneous catheter fracture, which is seen as a complication of subclavian venous catheterization.

Epidemiology

It is a known complication of central venous catheterization with a much-reduced incidence in current practice and is generally considered to be rare.

Radiographic features

Plain radiograph

An upright chest x-ray is mandatory post insertion. Look for catheter deviation, luminal narrowing and discontinuity (fracture) of the tube.

Grades of abnormality
  • grade 0: no narrowing in the catheter's course
  • grade 1: deviation of the catheter with no luminal narrowing
  • grade 2: luminal narrowing as the catheter passes under the clavicle (pinch-off sign)
  • grade 3: transection of the catheter between the clavicle and the 1st rib with embolization of the distal catheter

Complications

Reported complications include:

  • hemothorax
  • pneumothorax
  • vascular perforation
  • mediastinal hematoma
  • myocardial injury due to embolization of the distal catheter into the right atrium

Treatment and prognosis

Once detected on the chest x-ray immediate removal is advised.

History and etymology

Hinke et al. first described it in 1990.