Presentation
Shortness of breath, line placement.
Patient Data
Multifocal bilateral consolidation, endotracheal tube, nasogastric tube, and right-sided central line appropriately positioned, no pneumothorax. Left internal jugular catheter courses over the descending aorta.
Multifocal bilateral consolidation and bilateral pleural effusions. Left internal jugular catheter is in the hemi-azygos vein.
Case Discussion
There are 6 different possible locations for a central line that courses to the left of the midline: 1) aorta, 2) left superior vena cava, 3) hemiazygos vein, 4) left internal mammary artery, 5) left internal mammary vein, and 6) extravascular. Arterial blood return is most often seen with placement in the aorta. Internal mammary artery placement will also result in arterial blood return but is less common than aortic placement. Difficulty with blood return suggests an extravascular location. A left SVC is usually more lateral than in our case. A lateral view of the chest in the case of placement into the left internal mammary vein will show an anterior course, while placement into the hemiazygos vein will show a posterior course. CT showed that the line was in the hemiazygos vein.
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