J Korean Soc Radiol.  2014 Jan;70(1):43-46. 10.3348/jksr.2014.70.1.43.

Extravasation of Joint Fluid into the Mediastinum and the Deep Neck during Arthroscopic Shoulder Surgery

• Han JY
• Lee KN

• KMID: 1897259
• DOI: http://doi.org/10.3348/jksr.2014.70.1.43

Abstract

Extravasation of shoulder joint fluid into the surrounding muscles during shoulder arthroscopic surgery is common and inevitable. Here, we report a case of massive extravasation of shoulder joint fluid leading to mediastinal and retrotracheal effusion after arthroscopic shoulder surgery. We will discuss the anatomical basis of fluid leakage from the shoulder to the mediastinum and to the deep neck on CT.

MeSH Terms

Arthroscopy
Joints*
Mediastinum*
Muscles
Neck*
Shoulder Joint
Shoulder*

Figure

• 

  Fig. 1 Spaces of potential fluid leakage from the shoulder. Fluid extravasation occurs when arthroscopic shoulder surgery is performed at the subacromial space. Three ports were inserted near the acromion [anterolateral, posterior (not seen in the figure), and lateral to the acromion], and the anteroinferior port was inserted near the coracoid process. Spaces of potential fluid leakage are along the margin of the deltoid muscle and through the arthroscopic port that penetrates the deltoid muscle (arrows). A large amount of fluid might have accumulated in the subcutaneous fat anterior to the pectoralis major muscle in this course.

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  Fig. 2 Fluid leakage during shoulder arthroscopy in a 59-year-old woman. A. Enhanced chest CT scan shows a large amount of fluid accumulation in the subcutaneous fat layer of the anterior chest wall (star). Fluid is also noted in the posterior chest wall, permeating the right rhomboid and the right latissimusdorsi muscles (arrows). B. Enhanced chest CT scan at the level of the upper neck shows fluid in the retropharyngeal space (star), right posterior cervical space (triangle), and right submandibular space (square). Fluid splayed between the carotid space and anterior scalene muscle to enter into the retropharyngeal space of the neck (arrow). C. Thin-section CT scan of the lung shows smooth interlobular septal thickening in the right apex and the focal ground glass opacity in left apex medial aspect (arrow). D. Coronal-reformatted chest CT scan shows that the fluid around the subclavian vein continues to the mediastinum (arrows).

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