rss
BMJ Case Reports 2010; doi:10.1136/bcr.04.2010.2902
  • Images in…

Misplaced central venous catheter?

  1. Thiagarajan Jaiganesh
  1. Emergency Department, St George's Hospital, London, UK
  1. Correspondence to Thiagarajan Jaiganesh, jaiganesh{at}doctors.org.uk
  • Published 10 August 2010

Description

We report a very unusual chest x-ray finding in a 23-year-old woman who attended our Emergency Department (ED) after sustaining a respiratory arrest following a seizure. She had a complicated medical history having undergone spinal surgery, a tracheostomy and having experienced hypoxic brain injury. She was resuscitated and ventilated and a right subclavian central line was inserted as part of her management prior to transferring her to the intensive care unit (ITU). On chest x-ray the right central line catheter was noted to have taken a rather unusual route of traversing the midline (figure 1). As all ports were aspirating blood, the central venous pressure trace was of normal pattern and, as there were no issues using the line, it remained in situ and an anomalous brachiocephalic vein anatomy was considered to be the cause of the unusual x-ray finding.

Figure 1

Chest x-ray: right subclavian catheter traversing the midline.

Various patterns of unusual brachiocephalic anatomy have been identified in the past particularly due to problems during embryogenesis.1 The pattern shown in our x-ray is due to the anomalous left brachiocephalic vein terminating in line with the right subclavian vein rather than in its usual lower position. The anomalous left brachicephalic veins usually runs behind the aortic arch and above the pulmonary artery. These anomalies may coexist with other great vessel and cardiac anomalies, including tetrology of Fallot and ventricular septal defects.2

Anatomical variations may occur, and they have implications for placement of central lines in the ED. Abnormally placed lines may be retained if they meet the characteristics and clinical need, as in our case. However, some of them may have to be removed if there is a clinical suspicion that they may cause additional harm or not be clinically useful.

Footnotes

  • Competing interests None.

  • Patient consent Obtained.

References

Register for free content

The full text of all Editor's Choice articles and summaries of every article are free without registration

The full text of Images in ... articles are free to registered users

Only fellows can access the full text of case reports (apart from Editor's Choice) - become a fellow today, or encourage your institution to, so that together we can grow and develop this resource

Don't forget to sign up for content alerts so you keep up to date with all the case reports as they are published, and let us know what you think by commenting on the Editor's blog

Navigate This Article