From the Cava to the Chest: Partial Anomalous Pulmonary Venous Connection

A 53-year-old man presented with pancreatitis with acute renal injury requiring renal replacement therapy and shock requiring vasopressor infusion. Therefore, he placed the left internal jugular dialysis catheter under ultrasound guidance. The wires were easily threaded and the connectors were properly flushed and evacuated. Post-procedure chest radiographs showed a left internal jugular vein catheter that appeared to end in the right chest across the patient's median. Cross-sectional images identified a catheter leading from the right median lobe through the superior vena cava to the abnormal pulmonary vein. Subsequent venography showed no extravasation. The catheter was removed and balloon angioplasty of the superior vena cava was performed to ensure hemostasis. The patient recovered from his acute illness and was discharged to an assisted living facility without the adverse effects of his line deformation. Partial pulmonary venous connection disorders are congenital cardiac abnormalities with an incidence between 0.1% and 0.7% (14). The majority of patients are asymptomatic and diagnosis is often based on accidental radiographic findings (1,4). Indications for repair include a ratio of pulmonary blood flow to systemic blood flow above 2: 1 (5). Our patient was referred to Congenital Cardiology to examine post-recovery repair from his illness.