PICC

Case 30

ICU/Surgery, Lines/Tubes/Devices / , , , , , , , ,

This radiograph demonstrates a misplaced right IJ Swan-Ganz catheter. Not only is the catheter too deep in the right pulmonary artery, the course of the catheter extends all the way into the abdominal IVC before looping back into the right atrium and crossing the tricuspid valve. Other lines and devices include a left upper extremity PICC with the tip terminating in the SVC, and an intra-aortic balloon pump (IABP) with the distal marker appropriately located just inferior to the aortic knob.

The cardiac silhouette is prominent and there is mild interstitial edema, which makes sense in the context of an IABP indicating that the patient is in heart failure.

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Case 24

Lines/Tubes/Devices, Normal & Variants / , , ,

This radiograph demonstrates a left upper extremity peripherally inserted central catheter (PICC) with tip terminating in a persistent left SVC. The presence of a persistent left SVC was confirmed on review of prior cross sectional imaging. A PICC in the internal thoracic vein can have a similar appearance on AP/PA radiographs, however a lateral radiograph easily distinguishes the two as a persistent left SVC will course centrally and the internal thoracic vein will course anteriorly.

The radiograph is otherwise unremarkable.

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Case 14

Lines/Tubes/Devices / , , , ,

This radiograph demonstrates a malpositioned left upper extremity PICC (peripherally inserted central catheter). The tip is turned upward within the superior vena cava and is beginning to course medially, consistent with placement in the azygous vein. A lateral radiograph may be helpful to confirm, if available. The study is otherwise unremarkable for the patient’s age.

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