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Clinical Images

Where is the Left Central Venous Catheter Inserted?

Abubakr Bajwa, Candice Baldeo, Ena Gupta, Avinash Ramdass

April 3, 2015

A 62 year old male with COPD, CAD with AICD implantation, and OSA was admitted for worsening dyspnea. Severe pulmonary artery hypertension was confirmed with right heart catheterization and echocardiography and he was started on intravenous epoprostenol.

Chest X-ray following insertion of a left central venous catheter showed likely placement of the catheter in the internal carotid artery (Figure 1). However, pressures transduced from this newly placed catheter displayed a venous waveform with pressures ranging from 7-15mmHg suggesting that this was not an arterial catheterization. CT chest revealed a left azygous vein in which the catheter had engaged (Figure 2).

Left-central-venous-catheter-Figure-1.png

 Figure 1

Left-central-venous-catheter-inserted-Figure-2.png
Figure 2


 


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References

  1. Suat Keskin, Zeynep Keskin,Nevin Sekmenli. The Independent Right and Left Azygos Veins with Hemiazygos Absence: A Rare Case Presentation. Case Reports in Vascular Medicine, Volume 2013, Article ID 282416.
  2. Lydia S Quadros, Bhagath Kumar Potu, Anitha Guru,Thejodhar Pulakunta, Biswabina Ray, Suhani Sumalatha D’Silva,Sylvia Sequeira and Huban Thomas. Anomalous azygos venous system in a south Indian cadaver. A case report. Cases Journal 2009, 2:6746.

 

Authors

Candice Baldeo-PGY2 Internal Medicine resident at University of Florida, Jacksonville.

Ena Gupta- PGY2 Internal Medicine resident at University of Florida, Jacksonville.

Avinash Ramdass-First year fellow in Pulmonary/Critical Care at University of Florida, Jacksonville.

Abubakr Bajwa-Attending in Pulmonary/Critical Care at University of Florida, Jacksonville.