Iatrogenic Thoracic Duct Injury via the Right Internal Jugular Vein: A Case Report
Bibliographic record
Abstract
Thoracic duct injury is a rare mechanical complication during the insertion of a central venous cannula via the left internal jugular vein. We report a case of thoracic duct injury during the insertion of a temporary pacing lead via the right internal jugular vein. A 92-year-old woman presented with third-degree atrioventricular block. Temporary ventricular pacing was attempted via the right internal jugular venous route, but a guidewire and sheath migrated into the vessel structure that was not directly connected to the right ventricle. Considering the characteristics of the fluid obtained from the vessel and the anatomical components of the mediastinum, a diagnosis of thoracic duct injury was made. The system inserted incorrectly was removed and a pacing lead was placed in the right ventricular apex through the right internal jugular vein. Her clinical course was uneventful without developing pneumothorax, hemothorax, or chylothorax, and 5 days later, a permanent pacemaker was implanted via the left subclavian venous route.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.007 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.004 | 0.003 |
| Science and technology studies | 0.004 | 0.003 |
| Scholarly communication | 0.004 | 0.004 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.011 | 0.005 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".