HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Funaki, B. Search for Related Content PubMed PubMed Citation Articles by Funaki, B. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?

Central Venous Access: A Primer for the Diagnostic Radiologist

¹ Department of Radiology, The University of Chicago Hospitals, 5841 S. Maryland Ave., Chicago, IL 60637.

View larger version (86K): [in a new window]   Fig. 1. —Photograph shows peripherally inserted central venous catheter.

View larger version (94K): [in a new window]   Fig. 2. —Photograph shows temporary (small arrow) and permanent (large arrow) central venous catheters.

View larger version (108K): [in a new window]   Fig. 3A. —Dual-lumen implantable chest port. Photograph shows kit used for port insertion.

View larger version (123K): [in a new window]   Fig. 3B. —Dual-lumen implantable chest port. Fluoroscopic image shows port inserted via right internal jugular vein of 54-year-old man.

View larger version (150K): [in a new window]   Fig. 4A. —Catheter placement into collateral vein in 37-year-old man with central venous occlusion requiring hemodialysis. Venogram obtained through end-hole catheter advanced from common femoral vein into superior vena cava shows numerous small collateral veins in chest and neck. Jugular and subclavian veins are occluded.

View larger version (160K): [in a new window]   Fig. 4B. —Catheter placement into collateral vein in 37-year-old man with central venous occlusion requiring hemodialysis. Fluoroscopic image shows snare loop in collateral neck vein.

View larger version (131K): [in a new window]   Fig. 4C. —Catheter placement into collateral vein in 37-year-old man with central venous occlusion requiring hemodialysis. Fluoroscopic image shows needle puncture through loop of snare. Needle is exchanged for guidewire, and snare is used to pull guidewire into superior vena cava, securing venous access.

View larger version (152K): [in a new window]   Fig. 4D. —Catheter placement into collateral vein in 37-year-old man with central venous occlusion requiring hemodialysis. Final fluoroscopic image shows dual-lumen tunneled catheter.

View larger version (140K): [in a new window]   Fig. 5A. —Cephalad catheter migration attributed to downward retraction of breast tissue in 39-year-old woman. Supine fluoroscopic image shows catheter tip in proximal right atrium.

View larger version (124K): [in a new window]   Fig. 4B. —Cephalad catheter migration attributed to downward retraction of breast tissue in 39-year-old woman. Upright chest radiograph shows that tip has migrated to upper superior vena cava.

View larger version (162K): [in a new window]   Fig. 6. —Fluoroscopic image shows catheter malpositioned in left internal jugular vein of 49-year-old man.

View larger version (126K): [in a new window]   Fig. 7. —Fluoroscopic image shows atypical medial position of left internal jugular vein hemodialysis catheter in azygous vein of 43-year-old man.

View larger version (138K): [in a new window]   Fig. 8A. —Atypical catheter position in 2-year-old boy. Chest radiograph shows that peripherally inserted central venous catheter terminates in left side of mediastinum.

View larger version (150K): [in a new window]   Fig. 8B. —Atypical catheter position in 2-year-old boy. Venogram obtained through catheter shows left-sided superior vena cava draining into coronary vein.

View larger version (131K): [in a new window]   Fig. 9A. —Partial anomalous pulmonary venous return in 54-year-old man. Chest radiograph obtained after bedside insertion of left internal jugular vein temporary catheter shows tip (arrow) projecting over left lung.

View larger version (145K): [in a new window]   Fig. 9B. —Partial anomalous pulmonary venous return in 54-year-old man. Venogram obtained through catheter shows tip in left vertical vein (anomalous pulmonary vein). Blood drawn from catheter had arterial-oxygen partial pressure confirming that structure was anomalous pulmonary vein rather than left pericardiophrenic vein, which has similar course.

View larger version (137K): [in a new window]   Fig. 9C. —Partial anomalous pulmonary venous return in 54-year-old man. Chest radiograph obtained after surgical placement of left subclavian chest port shows tip projecting over right lung.

View larger version (154K): [in a new window]   Fig. 9D. —Partial anomalous pulmonary venous return in 54-year-old man. Venogram obtained through chest port shows tip in right anomalous pulmonary vein. Blood aspirated from catheter also had arterial-oxygen partial pressure.

View larger version (152K): [in a new window]   Fig. 10A. —Arterial insertion of central catheter in 72-year-old woman. Postplacement chest radiograph shows left subclavian catheter (arrows) that assumes slightly more medial course than is typical.

View larger version (157K): [in a new window]   Fig. 10B. —Arterial insertion of central catheter in 72-year-old woman. Digital subtraction angiogram confirms that tip terminates in aorta. Contrast material was rapidly diluted by high flow in ascending aorta.

View larger version (124K): [in a new window]   Fig. 11A. —Great vessel perforation in 48-year-old man. Chest radiograph shows widening of mediastinum and atypical leftward course of indwelling right subclavian vein dual-lumen chest port (arrow).

View larger version (126K): [in a new window]   Fig. 11B. —Great vessel perforation in 48-year-old man. Infused chest CT scan shows catheter (arrow) anterior to contrast media—filled right subclavian vein.

View larger version (126K): [in a new window]   Fig. 11C. —Great vessel perforation in 48-year-old man. Lower image of chest CT scan shows catheter tip in extravascular space of mediastinum anterior to trachea (arrow) with adjacent hemorrhage.

View larger version (129K): [in a new window]   Fig. 12A. —Catheter pinch-off and migration in 54-year-old man. Chest radiograph shows left subclavian chest port (arrow) with compression by costoclavicular ligament complex.

View larger version (152K): [in a new window]   Fig. 12B. —Catheter pinch-off and migration in 54-year-old man. Fluoroscopic image shows catheter fracture.

View larger version (140K): [in a new window]   Fig. 12C. —Catheter pinch-off and migration in 54-year-old man. Fluoroscopic image shows fragment captured by snare.

View larger version (107K): [in a new window]   Fig. 12D. —Catheter pinch-off and migration in 54-year-old man. Fluoroscopic image shows fragment being removed via left common femoral vein.

CiteULike

Complore

Connotea

Del.icio.us

Digg

Reddit

Technorati