Partial anomalous pulmonary vein drainage of the left lower lobe: Incidental diagnostic after central venous cannulation

Abstract

OBJECTIVE: To report a case of partial anomalous pulmonary vein drainage of the left lower lobe diagnosed after central venous cannulation. DESIGN: Retrospective case review. SETTING: Intensive care unit. PATIENT: A 76-yr-old woman with obstructive acute renal failure requiring hemodialysis. INTERVENTIONS: Central venous cannulation and hemodialysis. MEASUREMENTS AND MAIN RESULTS: The diagnosis was suggested by chest radiography after placement of a central venous catheter through the left internal jugular vein. Pressure measurements at the tip of the catheter showed a venous waveform. Oxygen blood content on samples of blood was higher than on peripheral arterial blood. Computed tomography with intravenous contrast was not conclusive. Diagnosis was confirmed with transcatheter phlebography. CONCLUSIONS: It is important for the intensivist to be aware of this infrequent variant when a central venous catheter takes an abnormal route and drains low-pressure, arterialized blood.