Central Venous Access: A Primer for the Diagnostic Radiologist

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Central Venous Access: A Primer for the Diagnostic Radiologist

Brian Funaki¹

^¹ Department of Radiology, The University of Chicago Hospitals, 5841 S. Maryland Ave., Chicago, IL 60637.

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Fig. 1. —Photograph shows peripherally inserted central venous catheter.

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Fig. 2. —Photograph shows temporary (small arrow) and permanent (large arrow) central venous catheters.

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Fig. 3A. —Dual-lumen implantable chest port. Photograph shows kit used for port insertion.

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Fig. 3B. —Dual-lumen implantable chest port. Fluoroscopic image shows port inserted via right internal jugular vein of 54-year-old man.

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Fig. 4A. —Catheter placement into collateral vein in 37-year-old man with central venous occlusion requiring hemodialysis. Venogram obtained through end-hole catheter advanced from common femoral vein into superior vena cava shows numerous small collateral veins in chest and neck. Jugular and subclavian veins are occluded.

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Fig. 4B. —Catheter placement into collateral vein in 37-year-old man with central venous occlusion requiring hemodialysis. Fluoroscopic image shows snare loop in collateral neck vein.

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Fig. 4C. —Catheter placement into collateral vein in 37-year-old man with central venous occlusion requiring hemodialysis. Fluoroscopic image shows needle puncture through loop of snare. Needle is exchanged for guidewire, and snare is used to pull guidewire into superior vena cava, securing venous access.

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Fig. 4D. —Catheter placement into collateral vein in 37-year-old man with central venous occlusion requiring hemodialysis. Final fluoroscopic image shows dual-lumen tunneled catheter.

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Fig. 5A. —Cephalad catheter migration attributed to downward retraction of breast tissue in 39-year-old woman. Supine fluoroscopic image shows catheter tip in proximal right atrium.

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Fig. 4B. —Cephalad catheter migration attributed to downward retraction of breast tissue in 39-year-old woman. Upright chest radiograph shows that tip has migrated to upper superior vena cava.

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Fig. 6. —Fluoroscopic image shows catheter malpositioned in left internal jugular vein of 49-year-old man.

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Fig. 7. —Fluoroscopic image shows atypical medial position of left internal jugular vein hemodialysis catheter in azygous vein of 43-year-old man.

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Fig. 8A. —Atypical catheter position in 2-year-old boy. Chest radiograph shows that peripherally inserted central venous catheter terminates in left side of mediastinum.

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Fig. 8B. —Atypical catheter position in 2-year-old boy. Venogram obtained through catheter shows left-sided superior vena cava draining into coronary vein.

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Fig. 9A. —Partial anomalous pulmonary venous return in 54-year-old man. Chest radiograph obtained after bedside insertion of left internal jugular vein temporary catheter shows tip (arrow) projecting over left lung.

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Fig. 9B. —Partial anomalous pulmonary venous return in 54-year-old man. Venogram obtained through catheter shows tip in left vertical vein (anomalous pulmonary vein). Blood drawn from catheter had arterial-oxygen partial pressure confirming that structure was anomalous pulmonary vein rather than left pericardiophrenic vein, which has similar course.

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Fig. 9C. —Partial anomalous pulmonary venous return in 54-year-old man. Chest radiograph obtained after surgical placement of left subclavian chest port shows tip projecting over right lung.

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Fig. 9D. —Partial anomalous pulmonary venous return in 54-year-old man. Venogram obtained through chest port shows tip in right anomalous pulmonary vein. Blood aspirated from catheter also had arterial-oxygen partial pressure.

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Fig. 10A. —Arterial insertion of central catheter in 72-year-old woman. Postplacement chest radiograph shows left subclavian catheter (arrows) that assumes slightly more medial course than is typical.

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Fig. 10B. —Arterial insertion of central catheter in 72-year-old woman. Digital subtraction angiogram confirms that tip terminates in aorta. Contrast material was rapidly diluted by high flow in ascending aorta.

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Fig. 11A. —Great vessel perforation in 48-year-old man. Chest radiograph shows widening of mediastinum and atypical leftward course of indwelling right subclavian vein dual-lumen chest port (arrow).

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Fig. 11B. —Great vessel perforation in 48-year-old man. Infused chest CT scan shows catheter (arrow) anterior to contrast media—filled right subclavian vein.

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Fig. 11C. —Great vessel perforation in 48-year-old man. Lower image of chest CT scan shows catheter tip in extravascular space of mediastinum anterior to trachea (arrow) with adjacent hemorrhage.

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Fig. 12A. —Catheter pinch-off and migration in 54-year-old man. Chest radiograph shows left subclavian chest port (arrow) with compression by costoclavicular ligament complex.