Trudno?ci diagnostyczne w ustaleniu położenia cewnika centralnego u chorej z nietypowym przebiegiem żyły ramienno-głowowej lewej i żyły nieparzystej – opis przypadku

*Robert Włodarski, Przemysław Michna, Anna Jurecka

Summary
Background. Cannulation of the superior vena cava is a routine procedure in intensive therapy, and may be complicated by atypical anatomy or technical problems. We describe a case in which the central venous catheter migrated to the azygos vein.
Case report. A 55-year-old woman was admitted to the ITU because of severe sepsis complicating bowel cancer surgery. A triple-lumen catheter was inserted using a Seldinger technique, into the left subclavian vein to a distance of 15 cm. A subsequent chest X-ray revealed the catheter to be located within the aortic arch. Blood gas analysis and direct pressure monitoring indicated a venous location of the catheter. A 3D CT scan was performed, revealing an abnormal position of the left brachiocephalic vein, draining to the azygos vein, and to the right brachiocephalic vein.
Discussion. Congenital malformations of major veins are rare and usually asymptomatic. They may however, complicate venous cannulation. In the case described, the catheter inserted via the left subclavian vein was visible within the aortic arch during standard X-ray examination. 3D CT scan reconstruction allowed for the precise location of the catheter, which had migrated to the azygos vein located behind the aortic arch.

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