Vascular anomaly diagnosis by central venous catheter misplacement: a case report

Abstract

Background: Congenital heart diseases rarely have a primary manifestation in adulthood. They are a rare cause of pulmonary hypertension in adults.

Case presentation: A 70-year-old woman of Eurasian descent underwent emergency surgery for bowel ischemia. Her history of mild pulmonary hypertension likely correlates with a peculiar diagnosis of an anatomic anomaly on the postoperative x-ray and computed tomography scan. The central venous catheter was misplaced. Initial management consisted of removal of the catheter. The diagnosis, partial anomalous pulmonary venous return, may pose a clinical therapeutic dilemma.

Conclusions: Partial anomalous pulmonary venous return is a potentially treatable cause of pulmonary hypertension. With the current trend toward more medical imaging, we expect this diagnosis to be made more often in the future.

Keywords: Cardiac vascular anatomy; Central venous catheter; Congenital heart disease; Pulmonary hypertension.

Fig. 1

Chest X-ray showing the central venous catheter in abnormal position, peripherally in the left lung

Fig. 2

Multiplanar reconstruction image from the chest computed tomography examination. The intravenous catheter (red arrow) travels through the left jugular vein and would be expected to continue in the left brachiocephalic vein (white arrow). In this case, however, the route of least resistance was in the retrograde direction through the anomalous left superior pulmonary vein (green arrow head). Also visible are the superior vena cava (VCS), the aortic arch (Ao), and the left and right pulmonary artery (LPA, RPA)