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LETTER TO THE EDITOR

Central Venous Catheter in the Sigmoid Sinus

Department of Radiodiagnosis; Sanjay Gandhi Postgraduate Institute of Medical Sciences; Lucknow; Uttar Pradesh; India; ssbaijal{at}sgpgi.ac.in

To the Editor:

Many case reports describe unintended meanderings of central venous catheters. Our patient was a 67-yr-old female scheduled for arterial stimulation and venous sampling for a suspected insulinoma. The patient had a central venous catheter placed earlier in the ward. We passed a guidewire through this catheter in an attempt to use it to guide our hepatic sampling catheter. Fluoroscopic imaging of the guidewire revealed that the catheter took a U turn in the internal jugular vein and wound up in the sigmoid sinus (Fig. 1). The catheter was withdrawn and repositioned without incident.

View larger version (69K): [in this window] [in a new window]   Figure 1. Fluoroscopic spot image showing the U-bend of central venous pressure line in the neck with the tip reaching the sigmoid sinus.

Image guidance has been shown to be useful for placing and subsequently confirming the location of the central venous pressure line's tip (1–3). Our report confirms the dictum that all central venous catheters should have their position confirmed radiographically.

REFERENCES

1. Funaki B. Central venous access: a primer for the diagnostic radiologist. AJR 2002;179: 309–18.[Free Full Text]
2. Vesely TM. Central venous catheter tip position: a continuing controversy. J Vasc Interv Radiol 2003;14:527–34.[Web of Science][Medline]
3. Espinet A, Dunning J. Does ultrasound-guided central line insertion reduce complications and time to placement in elective patients undergoing cardiac surgery. Interact Cardiovasc Thorac Surg 2004;3:523–7.[Abstract/Free Full Text]

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