Unusual Dialysis Catheter Location in a Transplant Patient.

Abstract

A 56-year-old woman, the recipient of a kidney transplant 8 years ago, was admitted to the nephrology intensive care unit with septic shock secondary to disseminated shingles after immunosuppressive therapy for acute cellular rejection. The patient developed AKI requiring RRT. Due to history of right internal jugular vein thrombosis related to previous vascular access, the left internal jugular vein was catheterized with a nontunneled double lumen hemodialysis catheter (12 French, 20 cm) without any complications. Routine postprocedure chest radiograph (Figure 1A) showed that the catheter was descending straight into the left border of the mediastinum. A transthoracic echocardiogram then showed enlarged coronary sinus with normal size cardiac chambers and no septal defects. Figure 1. Imaging studies exposing the persistent left superior vena cava. (A) Chest radiograph showing dialysis catheter descending straight to the left border of the mediastinum. (B) Anteroposterior three-dimensional computed tomography angiography (CTA) reconstruction revealing …