Inadvertent Central Venous Catheter Placement into a Partial Anomalous Pulmonary Venous Connection: A Case Report

Fig. 1).A bedside ultrasound examination confirmed the presence of the central line in the left internal jugular vein, although it could not be visualized beyond the root of the neck.Venous waveform with a pressure of 4 mm Hg was noted on connection to a pressure transducer.A bedside agitated saline test performed under ultrasound guidance yielded positive results.An arterial blood gas analysis from this CVC demonstrated a PaO₂ of 169 mm Hg compared with 87 mm Hg obtained from an existing arterial line.As the surgical team planned a CECT abdomen to assess for intra-abdominal collections, a decision was made to perform CT thoracoabdominal angiography.CT angiography revealed that the catheter traversed from the left internal jugular vein into an anomalous vascular communication between the left upper lobar IntroductIonCentral venous catheter (CVC) insertion is a commonly performed procedure in the management of critically ill patients, yet it remains associated with inherent risks, even when performed by experienced clinicians. 1 Postprocedural chest X-ray (CXR) is routinely employed to verify accurate catheter tip placement and to detect puncture-related complications. 2 If the catheter follows an unusual path on the CXR, further assessment is warranted, as such findings may occasionally reveal previously unrecognized congenital anomalies.3,4 We report a case of a 40-year-old male in whom a left-sided partial anomalous pulmonary venous connection (PAPVC) was incidentally identified following the placement of a left internal jugular CVC.A structured approach to the recognition and management of this situation is also discussed. case descrIptIonA 40-year-old male with no known comorbidities presented with pneumoperitoneum and mesenteric tear following a road traffic accident.Emergency exploratory laparotomy was performed, including Hartmann procedure and diversion ileostomy.Postoperatively, the patient experienced hemodynamic instability, necessitating vasopressor support via a CVC placed in the right internal jugular vein.Vasopressors were successfully discontinued over time, and total parenteral nutrition was administered through this CVC.On postoperative day 7, the CVC became occluded.It was decided to place a new 7 Fr CVC in the left internal jugular vein.The procedure was performed under ultrasound guidance using the Seldinger technique without complications.Postinsertion chest radiography was done, which revealed that the catheter tip did not cross the midline as anticipated and instead extended toward the left of the mediastinum 1,