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Case Reports
. 2022 Oct-Dec;44(4):597-601.
doi: 10.1590/2175-8239-JBN-2020-0263.

Persistence of left superior vena cava: a rare cause of hemodialysis tunneled catheter malposition

[Article in English, Portuguese]
Afonso Santos  1 , Ana Gaspar  1 , Anna Lima  1 , Catarina Brás  1 , Pedro Campos  1 , Célia Madeira  1 , Ana Nassauer Mónica  2 , Karina Soto  1
Affiliations
Case Reports

Persistence of left superior vena cava: a rare cause of hemodialysis tunneled catheter malposition

[Article in English, Portuguese]
Afonso Santos et al. J Bras Nefrol. 2022 Oct-Dec.

Abstract
in English, Portuguese

Hemodialysis central venous catheter (CVC) insertion can be complicated in patients with anomalous vessel anatomy. In such cases detailed knowledge of thoracic vessel anatomy is necessary to identify the exact location of the catheter. Central venous placement under ultrasound control has significantly reduced the complications associated with blind puncture and allows an appropriate puncture of the desired vessel, but the CVC can still get misplaced if it follows an anomalous route. Herein, we report a case of dialysis catheter placed into a left sided superior vena cava, only diagnosed after CT scan study.

A inserção do cateter venoso central (CVC) para hemodiálise pode ser complicada em pacientes com anatomia anômala dos vasos. Nesses casos, o conhecimento detalhado da anatomia do vaso torácico é necessário para identificar a localização exata do cateter. A colocação venosa central sob controle de ultrassom tem reduzido significativamente as complicações associadas à punção às cegas e permite uma punção apropriada do vaso desejado, mas o CVC ainda pode ficar mal posicionado se seguir uma rota anômala. Aqui, relatamos um caso de cateter de diálise colocado em uma veia cava superior esquerda, apenas diagnosticado após estudo de tomografia computadorizada.

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Conflict of interest statement

Conflict of Interest

The authors have no conflict of interests to declare.

Figures

Figure 1
Figure 1. Anterior-posterior chest radiograph. The tip of the catheter is in a left sided position. There is widening of the mediastinum with a regular pale opacity above the aortic knob.
Figure 2
Figure 2. Fluoroscopy. The tunneled catheter was partially removed until the tip was positioned in the right IJV and contrast was injected revealing absence of luminal permeability of right superior vena cava.
Figure 3
Figure 3. CT scan: Coronal MPR MIP image. Right IJV continues to the left where it receives the left IJV to form a left sided superior vena cava.
See this image and copyright information in PMC

References

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