Impending catheter perforation of superior vena cava: radiographic recognition

Migration of jugular or subclavian venous catheters into inferior tributaries of the brachiocephalic veins or into the azygos vein, with possible complications

“…This interpretation is open to question. It may be argued that this backward curve of the catheter, as shown in two of the three illustrations provided by Tocino and Watanabe [49], is more consistent with catheter migration into the azygos vein than in the SVC. It thus appears that the diagnosis of SVC perforation in all these cases is not well established and that an involvement of the azygos vein rather than the SVC is not excluded, at least in some cases.…”

“…The diagnosis was made on the basis of the frontal chest roentgenograms alone. No lateral chest films were obtained, except in some of the cases reported by Tocino and Watanabe [49], and no injection of contrast material or anatomic confirmation was described in any of the patients. In six of the nine cases of this type of SVC perforation reported by Tocino and Watanabe [49], the lateral chest roentgenograms showed a "gentle curve of the catheter from anterior to posterior", which was interpreted as a manifestation of endothelial injury with the tip of the catheter in the intramural position leading to perforation, and as a radiologic sign of impending SVC perforation.…”

“…More than 20 patients have been reported in whom a central venous catheter (almost always from the left subclavian or a left jugular vein), as seen on frontal roentgenograms, extended across the left BCV and the SVC, to end with the tip appearing to abutt against the lateral wall of this vessel almost at a right angle [10,14,[42][43][44][45][46][47][48][49]. All these patients developed hydrothorax and/or mediastinal widening, reportedly from extravasation of the infusate, with complete clearing of the findings after removal of the catheter.…”

Bedside Chest Radiography

“…6). 12 Although the risk is probably low, an intracardiac position of the central venous catheter in the right atrium or the ventricle may lead to valvular or endocardial lesions or cause arrhythmias. Myocardial perforation with hemopericardium and pericardial tamponade is a rare but potentially fatal complication [13][14][15] Central venous catheters are typically inserted using the Seldinger technique.…”

The use of central venous catheters for intravenous contrast injection for CT examinations

“…The radiograph can also be used to look for signs of impending erosion through the vessel, particularly the superior vena cava (SVC). A curve at the end of the CVC is highly suggestive of impending perforation and should prompt catheter repositioning [25]. Such a line should, therefore, not be used for contrast injection.…”