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Malposition of a Total Parenteral Nutrition Catheter in the Accessory Hemiazygos Vein
Author(s) -
Smith Douglas C.,
Pop Peter M.
Publication year - 1983
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1177/0148607183007003289
Subject(s) - medicine , catheter , radiography , chest radiograph , parenteral nutrition , vein , superior vena cava , thorax (insect anatomy) , anatomy , rib cage , persistent left superior vena cava , radiology , surgery , coronary sinus
A total parenteral nutrition catheter was surgically introduced into the left cephalic vein of a 31‐yr‐old man with regional enteritis. After placement, a frontal radiograph indicated malplacement of the catheter. Its left vertical para‐median position indicated a left internal thoracic vein, a persistent left superior cava, or a left superior intercostal‐accessory hemiazygos vein position. The left internal thoracic vein is very anterior within the thorax, a persistent left superior vena cava is centrally located, and the left superior intercostal‐accessory hemiazygos vein is quite posterior. A lateral radiograph revealed a markedly posterior catheter course, with its tip at the level of the vertebral bodies. A venogram confirmed its location within the left superior intercostal‐hemiazygos vein. The catheter was removed and replaced. After placement of all total parenteral nutrition catheters, a chest radiograph should be obtained. A single frontal film is usually adequate; if not, a supplemental lateral view may be taken. If uncertainty still exists, a venogram through the catheter may be obtained for precise localization.