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Small Right Internal Jugular Vein – Sign of Left Superior Vena Cava
- Lee A Plant, Timothy Digger (10 March 2006)
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Lee A Plant, Doctor Russells Hall Hospital, Timothy Digger
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Editor - Further to the case report of Ghadiali et al ¹, we would like to report a similar event that occurred while inserting a Hickman Line for chemotherapy in the hospital radiology department. Cannulation was achieved with the advantage of ultra sound guidance (U/S) and radiographic screening.
On initial examination of our patients neck with U/S a small diameter Right Internal Jugular Vein (RIJV) (approximately equal to the Right Carotid Artery) and a larger than normal size Left Internal Jugular Vein (LIJV) were visualised. Electing to cannulate the larger/easier vessel on the left side, straightforward needle puncture and easy passage of a J-tipped guide wire was performed using U/S. On radiographic screening the guidewire was seen to pass down the left mediastinal border. A cannula was advanced over the wire, the wire removed and intravenous contrast was injected via the cannula – this showed a normal Brachiocephalic vein and right sided SVC but also flow of contrast into a left sided SVC against blood flow. With radiological intervention, a 1.5m angio-guidewire was passed into the right sided SVC and a Hickman line placed.
We suggest that in view of both Ghadiali et al and our experience that patients with a left sided SVC (approx 0.2% of the population without other congenital cardiac disease²) may well have a small Right sided Internal Jugular Vein and that with the increasing use of U/S guided cannulation it would be of benefit to cannulate the smaller RIJV as this may prevent the complications of inadvertent left sided SVC placement as have been documented¹.
L. Plant
T. Digger
Russells Hall, UK
E-mail: leeplant@blueyonder.co.uk
1. Ghadiali N, Teo LM, Sheah K. Bedside confirmation of a persistent left superior vena cava based on abberantly positioned central venous catheter on chest radiograph. Br J Anaesth 2006; 96: 53 – 56
2. Armstrong P, Hansell D, Lynch D. Imaging of Diseases of the Chest, 3rd Edition. Elsevier Mosby 2004.
Conflict of Interest:None declared |
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