[1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17] [18] [19] [20] [21] [22] [23] [24] [25] [26] [27] [28] [29] [30] [31] [32] [33] [34] [35] [36] [37] [38] [39] [40] [41] [42] [43] [44] [45] [46] [47] [48] [49] [50] [51] [52] [53] Cent. Eur. J. Med. DOI: 1 Central European Journal of Medicine An unexpected position of the dialyses catheter during routine x-ray examination: a case of the double superior vena cava * E-mail: bruno.atalic@cantab.net Received 9 March 2013; Accepted 25 March 2013 Abstract: This paper presents a case of a 55 year old male patient, who after hospitalization at the Intensive Care Unit, due to acute renal failure, at frst had a central venous catheter inserted through his right subclavian vein, and then a dialysis catheter inserted through his left subclavian vein. A routine X-ray examination confrmed that the central venous catheter was visualised in the expected position of the right atrium, which was reached via superior vena cava. The dialysis catheter was not visualised in the expected position of the right atrium, but in the surprising location of the left ventricle, with its line continuously passing by the left sternal edge instead of crossing the middle line in order to enter the superior vena cava, thus raising a concern over its misplacement and possible side-effects (abstract image photo). Due to the absence of pneumo- or haemato-thorax, as the most common signs of the venous rupture, the possible explanation was an anatomical variation. Dialysis catheter displacement in the left internal thoracic vein was proposed as another possibility. Literature research explained it as a case of double superior vena cava, which was confrmed by analysis of the computerised tomography pulmonary angiogram. © Versita Sp. z o.o. Keywords: Vena cava superior • Anatomical variations • Radiology • Dialysis catheterisation • Central venous catheterisation 1 Clinical Department of Diagnostic and Interventional Radiology, Clinical Hospital Merkur, Zagreb, Croatia 2 Medical School Zagreb, Zagreb, Croatia 3 Department of Emergency Medicine, Zagreb, Croatia Bruno Atalić 1 *, Goran Sabo 2 , Jurica Toth 3 Case Report Figure. X rays examination conducted on the patient in lying position. 1. Introduction The superior vena cava is a large and short vein that carries deoxygenated blood from the upper half of the body to the right atrium. It is formed from the left and right brachiocephalic veins which receive blood from the upper limbs, head and neck. Duplication of the superior vena cava is a rare anomaly. Its incidence is 0.3% in general population and 10-11% in patients with congeni- tal heart disease. Its gender ratio is 1:1. Double superior vena cava cases have clinical importance if the left vein drains itself into the left atrium [1,2]. Double superior vena cava was frst described by Chouke in 1939. During the dissection of the body of a 50 year old man, who died from the chronic myocarditis, the left superior vena cava was observed together with the right superior vena cava. The former was formed by the union of the left internal jugular vein and the left sub- clavian vein, and descended vertically to the left of the arch of the aorta and to the back of the left atrium where