Presentation
Patient with usual interstitial pneumonia and pulmonary hypertension, new right central line with no blood return on aspiration.
Patient Data
Left PICC line tip projects over the expected location of the cavoatrial junction, right central line tip projects over the expected location of the superior vena cava. Reticulonodular pattern from known UIP, enlarged cardiac silhouette and main pulmonary artery secondary to pulmonary hypertension.
Right axillary contrast injection opacifies the SVC. The right central line is outside the SVC, the left PICC line is at the cavoatrial junction.
The left PICC line tip at the cavoatrial junction, the right central line is extravascular and is behind the superior vena cava in the right pleural space to the right of the spine. Small right pneumothorax and pleural effusion. Honeycombing, traction bronchiectasis, and increased septal lines from known UIP. Enlarged main pulmonary artery secondary to pulmonary hypertension.
Case Discussion
If blood cannot be aspirated from a central line, suspect extravascular placement. Non-contrast CT is best for confirmation. The malpositioned line was removed without incident.
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