Hemifacial Flushing
Hemifacial flushing developed in a 48-year-old man after he underwent laparoscopic cholecystectomy and pancreatic necrosectomy. After the induction of general anesthesia, a central venous catheter had been inserted into his left internal jugular vein under ultrasonographic guidance, without the use of local anesthetic infiltration. Hemifacial flushing was noted within 4 hours after the insertion of the central venous catheter. No additional findings suggestive of the harlequin syndrome or Horner's syndrome were identified. The flushing was probably due to obstruction of venous outflow by a thrombus surrounding the newly inserted central venous catheter, as observed by means of bedside ultrasonography. After removal of the central venous catheter, the hemifacial flushing promptly resolved.
