A 76-year-old patient was admitted to the Cardiology Department with acute myocardial infarction of anterior location complicated with heart failure.
It was decided to place a central venous catheter descending through the right subclavian vein.
A simple control chest X-ray shows an anomalous trajectory of the catheter that descends on the right side of the mediastinum to deviate subsequently following a left cardiac profile.
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In order to rule out the cannulation of an arterial vessel (right subclavian or common carotid), a tape record was requested (15pH: 7.35, pO2: 40, pCO2: 48) and intracatheter pressure was recorded.
Both demonstrate the existence of venous flow through the pathway.
Then, a Swan-Ganz catheter is implanted in the right main branch of the pulmonary artery, also through the right subclavian vein.
An echocardiogram showed dilation of the coronary sinus (1.5 cm diameter).
Inside the coronary sinus, the catheter is observed advocating the right atrium, the right ventricle and finally the pulmonary artery.
No other vein connects with the right atrium.
All these data are compatible with venous thrombosis, which consists of the persistence of the IVCSI with coronary sinus drainage, associated with the permeability of the anastomosis between the right and left venous systems.
