Central line malpositioned in the aorta

Case contributed by Craig Hacking
Diagnosis certain


Interhospital transfer. Intubated due to seizures.

Patient Data

Age: 70 years
Gender: Male

ETT is projected in the mid trachea. The right-sided central line courses more medial than expected with the tip projected within the ascending aorta or left ventricular outflow tract. The aortic arch is unfolded.

Blunting of the right costophrenic angle suggests a small pleural effusion. The lungs are clear. No evidence of air leak. Hilar contours are within normal limits. No cardiomegaly.

The misplaced right central venous catheter passes through the right internal jugular vein, enters the right subclavian artery and courses through the brachiocephalic trunk into the aortic arch. The tip lies within the ascending aorta, just above the aortic valve. No pericardial effusion.

The right and left common and internal carotid arteries opacify normally. There is a moderate short segment plaque of the proximal internal carotid arteries bilaterally. No carotid occlusion. The circle of Willis and major branches opacify normally. Normal opacification of the vertebral arteries.

ETT in situ. Apical pleural parenchymal scarring is noted. There are some small subpleural opacities within the upper lobes bilaterally.

Case Discussion

Accidental arterial placement of a venous catheter is an uncommon but serious complication. Careful assessment of line position on routine post-insertion CXR is vital to confirm adequate placement.

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