Intravenous contrast injection demonstrated extravasation and confirmed superior vena cava (SVC) injury (figure 1B). The patient remained haemodynamically stable and a decision was made to proceed with right thoracoscopy. Additional central venous and arterial access was obtained and the patient placed in left lateral decubitus position. A 5 mm endoscope was inserted along with two 5 mm instruments. The guidewire was seen passing out of the SVC through the pleura (figures 2A and 3A–C), this was grasped and retrieved via the thoracic cavity. A thrombin/gelatin haemostatic matrix (Floseal, Baxter) was applied along with direct pressure (figure 2B). There was no significant further bleeding. The patient made an uneventful recovery.

Sharif B, Wilkinson D, Zaparackaite I, Lansdale N. Superior vena cava injury during central venous catheter insertion in a young child: recognition and minimally invasive management. BMJ Case Rep. 2020 Oct 29;13(10):e236694. doi: 10.1136/bcr-2020-236694. PMID: 33122232.