VCU Thoracic Oct 16- 23 : Central venous line

Portable chest radiograph with accompanying edge enhanced image acquired on an ICU patient following a new central venous catheter deployment:



Describe the course and positioning of the new central venous catheter. Is this acceptable for use? What would you recommend be done if anything?

Diagnosis

Malpositioned Central Venous Catheter: Azygos-Hemi-azygos System

Radiologic Findings Portable AP chest radiograph (Fig. 1A) with the accompanying edge enhanced image (Fig. 1B) shows an anomalous course and positioning of the right internal jugular approach central venous catheter. Specifically, the catheter fails to extend below the right mainstem bronchus and follow the expected vertical course into the distal superior vena cava or proximal right atrium. Alternatively, at the tracheobronchial angle, the catheter enters the azygos vein, crosses the midline at approximately the T7 level, enters the inter-azygos vein and extends into the proximal hemi-azygos vein. There is no evidence of hemomediastinum, pleural effusion, or pneumothorax.

VCU Thoracic Sep 3- 10

Middle-aged woman several years out from coronary artery revascularization for coronary artery disease presenting with gradually worsening exertional dyspnea.

Describe the radiographic findings of concern. What is your leading diagnostic consideration?

What should be done next?