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Age: 34

Sex: Male

Indication: PICC placement

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Case #30


Findings

  • Left upper extremity PICC courses inferiorly along the left aspect of the mediastinum
  • Endotracheal tube projects 4 cm above the carina
  • NG/OG tube courses beyond the inferior border of the image with side-port overlying the gastric body
  • Thermistor overlies the upper thoracic esophagus
  • Widespread bilateral alveolar and interstitial opacification
  • Small bilateral pleural effusions
  • No pneumothorax
  • Cardiopericardial silhouette is partially obscured by adjacent pulmonary opacification, but appears normal in size


Diagnosis

  • Left SVC (and ARDS)

Sample Report

Left upper extremity PICC courses inferiorly along the left aspect of the mediastinum, possibly within an anomalous venous structure such as a left SVC, though arterial placement is difficult to exclude on this single radiographic view. Recommend correlation with any available prior cross-sectional imaging and with blood gas sampling from the catheter.

Remainder of the indwelling support apparatus projects in satisfactory position.

Widespread bilateral alveolar and interstitial opacification, which may relate to multifocal pneumonia, diffuse alveolar hemorrhage, or edema/ARDS.

Small bilateral pleural effusions.


Discussion

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Images

Subsequent CT in this patient shows a persistent left SVC coursing along the left aspect of the mediastinum and draining into the coronary sinus (red arrows). The patient had no left brachiocephalic vein.



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