Partial Anomalous Pulmonary and Systemic Venous Connection (PAPVC)

Abstract

Central venous catheter (CVC) is one of the most commonly placed invasive devices in critical care setup. Its placement can be associated with many technical complications like bleeding, pneumothorax, arterial puncture and infection. Furthermore technical and anatomical variations, unfavorable body habitus can lead to malpositioning of CVC within venous system even when they are placed under radiological guidance. If not addressed timely, malpositioning can be associated with poor catheter functioning and serious complications like vessel erosion, bleeding, thrombosis. Presence of congenital venous anomalies can be a rare cause of CVC malpositioning. We report a case of young female in whom CVC placed through left internal jugular venous (IJV) route accidentally entered into a left upper pulmonary vein through partial anomalous pulmonary venous connection (PAPVC) with the left brachiocephalic vein. Post insertion chest radiograph showed unusual curvilinear course of the left IJV access towards left pulmonary hilum. The diagnosis was clinched after contrast enhanced computed tomography delineated the previously undiagnosed venous anomaly in the patient. There is no report of CVC malposition into the pulmonary vein in medical literature making it unique and first of its kind. Malpositioned CVC can thus lead to revelation of asymptomatic congenital vascular anomalies in a completely unrelated clinical setting.