Dear colleagues,
Edgar; one of our young residents at Hospital Dr. Peset showed me this case:
62 year old woman.
Portable control after catheter placement.
Where is the catheter?:
1- In the pleura
2- In an artery
3- In a vein
4- In a bronchus
Check the image below, leave your thoughts in the comments section and come back on Friday for the answer.
Click here for the answer
CT: axial and coronal MIP projections. The jugular catheter enters the anomalous vessel through the innominate vein. The clue in the chest radiograph is the continuation of the catheter with the neck veins (Innominate, Jugular).
Diagnosis: Partial anomalous pulmonary venous drainage
Teaching point: Partial anomalous venous drainages are not frequent, the most common being the right lower lobe (scimitar). They are hemodynamically left to right shunts, and often asymptomatic but could lead to confusion especially when placing venous catheters or pacemakers.
3-in a vein
In pleura? Along major fissure? As a diagnosis of exclusion, because I can’t really think of any bronchus/artery/vein that runs like that.
Intravenous catheter placed in v.jugularis interna sininstra and v. brachiocephalica sin. The tip of the catheter is in the left inferior pulmonary vein – partial anomalous venous return to the left brachiocephalic vein.
In a vein (left superior intercostal vein?)
The first answers are going in the right direction but not completely…
In a vein
In a partial anomalous pulmonary venous return to the LVBC trunk?
(En un retorno venoso anomalo parcial hacia TVBC izq?)
In a partial anomalous pulmonary venous return to the LVBC trunk?
It seems for me in the pleura
In a vein
4. In a bronchus
In a vein (probably an anomalous partial venous pulmonary drainage terminating in the left brachiocefalic vein)
in vein
In a vein (anomalous partial venous return terminating in left brachiocefalic vein)
3) In a vein
OK. If this is a vein, do you have any specific suggestions ? ( Left superior intercostal vein is discarded being mediastinal ).
Hello!! rarely but I think it is in the pleural space
Can we see the lateral view?
No lateral, this is a portable radiograph, but I assure you that the catheter is not in the chest wall…
1- seems in the pleura – though I have never seen this type of complication, so considering the pre-test probability of this complication, I think my answer is wrong!
In a pulmonary vein – partial anomalous venous drainage to the left brachiocephalic vein.