An unexpected position of the dialyses catheter during routine x-ray examination: a case of the double superior vena cava

Abstract

Abstract This paper presents a case of a 55 year old male patient, who after hospitalization at the Intensive Care Unit, due to acute renal failure, at first had a central venous catheter inserted through his right subclavian vein, and then a dialysis catheter inserted through his left subclavian vein. A routine X-ray examination confirmed that the central venous catheter was visualised in the expected position of the right atrium, which was reached via superior vena cava. The dialysis catheter was not visualised in the expected position of the right atrium, but in the surprising location of the left ventricle, with its line continuously passing by the left sternal edge instead of crossing the middle line in order to enter the superior vena cava, thus raising a concern over its misplacement and possible side-effects (abstract image photo). Due to the absence of pneumo- or haemato-thorax, as the most common signs of the venous rupture, the possible explanation was an anatomical variation. Dialysis catheter displacement in the left internal thoracic vein was proposed as another possibility. Literature research explained it as a case of double superior vena cava, which was confirmed by analysis of the computerised tomography pulmonary angiogram.