Presentation
Increased work of breathing. Concern for respiratory distress syndrome. Check PICC placement.
Patient Data
There is a left arm PICC, which descends through the SVC, enters the right atrium, and then loops back superiorly to the left, likely within the left atrium.
There is an endotracheal tube in high position with the tip approximately 1 cm above the thoracic inlet. The umbilical arterial and venous catheters and an NG tube are well positioned.
The lungs are somewhat hyperexpanded and there are minimal hazy opacities, suggestive of respiratory distress syndrome.
Case Discussion
This is a case of a malpositioned left PICC line that terminates in the left atrium, likely through a patent foramen ovale in this neonate. The PICC was retracted and subsequent radiographs showed the PICC terminated in the superior vena cava.
Co-authors:
Travis Bevington, MD
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