Presenting the last case of “five easy pieces”. Images belong to a 58-year-old woman operated on for carcinoma of the rectum four months ago. She is admitted to the hospital complaining of moderate fever and abdominal pain.
What do you see?
Check the images below, leave your thoughts in the comments section, and come back on Friday for the answer.
Findings: in my opinion, the pre-op chest radiographs do not show any intrinsic abnormalities. The main finding is an abnormal path of the central venous line (CVL), which goes deep into the abdomen (A-B, arrows).
CT scout view shows the CVL in the right side of the abdomen (C, arrow). Coronal and sagittal reconstructions confirm the end of the CVL into the right renal vein (D-E, arrows). The catheter was removed and no complications ensued. The patient’s initial symptoms were caused by a pelvic abscess (not shown) successfully drained.
Final diagnosis: Malposition of the CVL into the right renal vein.
Congratulations to all who saw the abnormality, led by M A Fahmy who was first to mention it.
Teaching point: as I have said before, diagnosing malposition of a catheter is not very glamorous, but it can avoid significant complications to the patient (see Diploma cases 67 and 88).
