An unexpected position of the dialyses catheter during routine x-ray examination: a case of the double superior vena cava

• Authors: Bruno Atalić , Goran Sabo , Jurica Toth
• Languages of publication: EN

Abstracts

EN

This paper presents a case of a 55 year old male patient, who after hospitalization at the Intensive Care Unit, due to acute renal failure, at first had a central venous catheter inserted through his right subclavian vein, and then a dialysis catheter inserted through his left subclavian vein. A routine X-ray examination confirmed that the central venous catheter was visualised in the expected position of the right atrium, which was reached via superior vena cava. The dialysis catheter was not visualised in the expected position of the right atrium, but in the surprising location of the left ventricle, with its line continuously passing by the left sternal edge instead of crossing the middle line in order to enter the superior vena cava, thus raising a concern over its misplacement and possible side-effects (abstract image photo). Due to the absence of pneumo- or haemato-thorax, as the most common signs of the venous rupture, the possible explanation was an anatomical variation. Dialysis catheter displacement in the left internal thoracic vein was proposed as another possibility. Literature research explained it as a case of double superior vena cava, which was confirmed by analysis of the computerised tomography pulmonary angiogram.

Keywords

EN

Vena cava superior; Anatomical variations; Radiology; Dialysis catheterisation; Central venous catheterisation

• Publisher: De Gruyter Open
• Journal: Open Medicine
• Year: 2013
• Volume: 8
• Issue: 6
• Pages: 845-848

Dates

published

1 - 12 - 2013

online

6 - 12 - 2013

Contributors

author

Bruno Atalić

• Clinical Department of Diagnostic and Interventional Radiology, Clinical Hospital Merkur, Zagreb, Croatia

author

Goran Sabo

• Medical School Zagreb, Zagreb, Croatia

author

Jurica Toth

• Department of Emergency Medicine, Zagreb, Croatia

References

• [1] Thakor A.S., Massoud T., Double Superior Vena Cavae, BMJ Case Reports, 2009, 10, 1098, http://casereports.bmj.com/content/2009/bcr.10.2008.1098.full
• [2] Albay S., Cankal F., Kocabiyik N., Yalcin B., Ozan H., Double superior vena cava, Morphologie, 2006, 90, 39–42, http://www.ncbi.nlm.nih.gov/pubmed/16929820
• [3] Chouke K.S., A case of bilateral superior vena cava in an adult, The Anatomical Record, 1939, 74, 151–157, http://onlinelibrary.wiley.com/doi/10.1002/ar.1090740204/abstract http://dx.doi.org/10.1002/ar.1090740204[Crossref]
• [4] Minniti S., Visentini S., Procacci C., Congenital anomalies of the venae cavae: embryological origin, imaging features and report of three new variants, Eur Radiol, 2002, 12, 2040–2055, http://www.ncbi.nlm.nih.gov/pubmed/12136323
• [5] Gravereaux E.C., Nguyen L.L., Cunningham L.D., Congenital vascular anomalies, Curr Treat Options Cardiovasc Med, 2004, 6, 129–138, http://www.ncbi.nlm.nih.gov/pubmed/15066242 http://dx.doi.org/10.1007/s11936-004-0041-4
• [6] Sanders J.M., Bilateral superior vena cavae, Anat Rec, 1946, 94, 657–662, http://www.ncbi.nlm.nih.gov/pubmed/20981901 http://dx.doi.org/10.1002/ar.1090940407
• [7] Wennerstrand J.R., A case with a vena cava superior on both sides, Anat Anz, 1963, 112, 338–343, http://pubget.com/paper/13999958/A_case_with_a_vena_cava_superior_on_bothsides
• [8] Sahinoglu K., Cassell MD., Miyauchi R., Bergman RA., Human persistent left superior vena cava with doubled coronary sinus, Annals of Anatomy, 1994, 176, 451–454, http://www.ncbi.nlm.nih.gov/pubmed/7978342 http://dx.doi.org/10.1016/S0940-9602(11)80477-2
• [9] Ghatak T., Azim A., Baronia A.K., Muzaffar S.N., Malposition of central venous catheter in a small tributary of left brachiocephalic vein, J Emerg Trauma Shock, 2011, 4, 523–525, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3214515/?tool=pubmed
• [10] Nascimbene A., Angelini P., Superior vena cava thrombosis and paradoxical embolic stroke due to collateral drainage from the brachiocephalic vein to the left atrium, Tex Heart Inst J, 2011, 38, 170–173, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3066820/?tool=pubmed
• [11] Steinberg I., Dubilier Jr W., Lukas DS., Persistence of the left superior vena cava, Dis Chest, 1953, 24, 479–488, http://www.ncbi.nlm.nih.gov/pubmed/13107543 http://dx.doi.org/10.1378/chest.24.5.479

Identifiers

DOI

10.2478/s11536-013-0185-2