CTICasesCentral Venous Catheter Malposition into an Azygos Vein within an Azygos Lobe
Imaging findings
A central venous catheter placed via the left subclavian vein crossed the midline in the brachiocephalic vein and then hooked posteriorly and superiorly, entering the azygos vein rather than descending into the superior vena cava. In this patient the azygos vein coursed through an azygos lobe, so the catheter tip terminated within the vein of the azygos lobe out in the lung periphery, confirmed on CT and a lateral radiograph.
Key takeaways
A catheter that hooks posteriorly and superiorly rather than descending into the SVC should raise suspicion for azygos vein malposition. When an azygos lobe is present, its more superiorly and laterally displaced azygos vein origin may provide a more direct path for a left-sided catheter, potentially predisposing to this malposition, so recognizing azygos lobe anatomy helps explain and identify this uncommon catheter course.
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