CTICasesArterial Central Venous Catheter Placement (into aorta) via IJ and Subclavian Vein
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Imaging findings
Chest radiograph of a patient with multiple myeloma and sepsis showed a left-sided central venous catheter with a course suspicious for arterial placement, confirmed by transduction. Subsequent CT demonstrated the catheter tracking through the internal jugular vein and subclavian vein, then directly into the aorta, explaining its less medial position than typical carotid artery placements. A septic embolus from a prior infected right-sided catheter was also noted.
Key takeaways
Ultrasound guidance for central venous catheter placement requires clear visualization of the needle tip to prevent inadvertent arterial cannulation, especially in complex vascular anatomy. Arterial misplacement of a central line can occur even with ultrasound guidance, highlighting the importance of post-procedure imaging and waveform assessment.
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