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IJV catheter in left upper lobe partial anomalous pulmonary venous return

Case contributed by Daniel MacManus
Diagnosis certain

Presentation

ICU patient had internal jugular vein catheter inserted.

Patient Data

Age: 55 years
Gender: Female

The left internal jugular vein catheter (IJC) courses inferiorly in the left neck and passes to the left mediastinum and loops superiorly in the left upper zone.

Other findings: Consolidative changes in the right lung. ET-tube and NG-tube in-situ. Overlying cardiac monitoring probes and wires.

CT chest performed to exclude IJV puncture.

The left-sided internal jugular vein catheter courses inferior to the left sternocleidomastoid and into the left subclavian vein, left brachiocephalic vein and into the left upper lobe pulmonary vein anomaly. The tip of the catheter is seen within a left posterior segment upper lobe pulmonary vein.

Other findings: consolidative changes in the lungs. ET-tube and NG-tube in-situ.

Case Discussion

Partial anomalous pulmonary venous return (PAPVR) is a rare condition in which some pulmonary veins drain via an aberrant pathway directly into the systemic circulation instead of the left atrium.

This case demonstrates a supra-cardiac type with the left upper lobe pulmonary vein anomaly draining into the left brachiocephalic vein. 

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