Management of a malpositioned central venous catheter in the accessory hemiazygos vein

Malposition of a central venous catheter (CVC) in the accessory hemiazygos vein is an uncommon but potentially fatal complication; however, there is limited information regarding the preferred removal technique. We report a patient, a 57-year-old woman, who presented with overdose of her prescribed sedatives, who experienced this catheter complication after CVC insertion in the left internal jugular vein. The CVC was placed without resistance but routine postplacement chest X-ray showed abnormal coursing of the catheter close to the descending aorta. We used non-enhanced CT as an adjunct to safely identify the catheter position and assess for any bleeding during removal. CT images taken after retraction of the catheter tip by 10 cm showed no bleeding and we were able to remove the catheter safely. We recommend using CT as an adjunct to safely remove malpositioned catheters and reduce the risk of further complication.

An unusual umbilical venous connection to a left posterior intercostal vein

A foetal echocardiogram, in a 27-week foetus referred for cardiomegaly, demonstrated dextrocardia, absence of the ductus venosus, and an unrestricted unusual umbilical venous drainage to a left posterior intercostal vein, which continued to left hemiazygos vein and drained into the coronary sinus. Progressive cardiomegaly led to early delivery. To the best of our knowledge, no case with similar umbilical venous drainage has been previously reported.

Off-pump direct hepatic veins-to-hemiazygos vein anastomosis after primary Kawashima operation: long-term result

Direct hepatic veins-to-hemiazygos connection offers the balanced distribution of hepatic venous blood to both lungs, not requiring anticoagulation. We report a 13-year follow-up after this type of off-pump Fontan completion. Patient’s hepatic veins-to-hemiazygos confluence increased with growth to allow for unobstructed flow. This unique technique can be recommended in heterotaxy patients, if atrial hepatic venous drainage and hemiazygos vein are in close proximity.

Anatomical Variation of the Azygos System of Veins - Case Report

Introduction The azygos system of veins (ASV) is a very variable structure characterized as a communication between the inferior and superior vena cava, having the azygos vein (AV), the hemiazygos vein (HV), and the accessory hemiazygos vein (HAV) as its main components, which are responsible for the mediastinal viscera and for the thoracoabdominal wall drainage. The aim of the present study is to report an anatomical variation found in a male cadaver at the Laboratory of Anatomy of the University Center of UNIFACISA, Campina Grande, PB, Brazil. Case Report In the posterior mediastinum, the union of the HV, of the HAV, and of the 8th left posterior intercostal vein formed a common trunk at the level of the left 8th intercostal space, crossing the mediastinum posterior to the aorta artery, ending up in the AV, in the right hemithorax. Conclusion The study of the anatomical variations of the ASV is important and will provide knowledge for physicians not to confuse them with pathological processes in imaging exams. Moreover, it can provide safety in surgical approaches of the thorax.