Malposition of a Left-Sided Tunneled Hemodialysis Catheter into the Azygos Vein: A Case Report

Authors

  • Muhammad Naveed Alam Shah Department of Internal Medicine, Mufti Mehmood Memorial Teaching Hospital, Dera Ismail Khan, Pakistan
  • Fawad Ahmed Department of Internal Medicine, Mufti Mehmood Memorial Teaching Hospital, Dera Ismail Khan, Pakistan
  • Behzad Kaleem Baloch Department of Nephrology, Mufti Mehmood Memorial Teaching Hospital, Dera Ismail Khan, Pakistan

DOI:

https://doi.org/10.51253/pafmj.v76iSUPPL-3.13563

Keywords:

Azygos Vein, Central Venous Catheters, Nephrology

Abstract

Central venous catheterization through the left internal jugular vein poses a rare yet considerable danger of malposition into the azygos vein caused by anatomical angulation and reduced vessel caliber. We introduce the situation of an older woman suffering from chronic kidney disease and heart failure who experienced tunneled hemodialysis catheter placement employing a landmark-guided approach. Initially operational, the catheter was discovered incorrectly positioned in the azygos vein. The position was adjusted under fluoroscopic imaging. This situation highlights the significance of image-assisted insertion in averting such complications and emphasizes the importance of post-procedural imaging, particularly in left-sided catheterization.

Downloads

Download data is not yet available.

References

1. Asudani D, Wretzel S, Patel R, Stayman A. A judgment call. Cleve Clin J Med 2008; 75(10): 690–691.

https://doi.org/10.3949/ccjm.75.10.690

2. Nayeemuddin M, Pherwani AD, Asquith JR. Imaging and management of complications of central venous catheters. Clin Radiol 2013; 68(5): 529–544.

https://doi.org/10.1016/j.crad.2012.10.013

3. Hajeh H, Garcia A, Mishra S, Radicic K. Malposition of the central venous catheter secondary to accessory hemiazygos vein variant. J Vasc Access 2023; 25(3): 995–997.

https://doi.org/10.1177/11297298231154291

4. Li XY, Ye JB, Zhang LG, Jia YZ, Zhou RM, Pai P. Misplacement of Tunneled Hemodialysis Catheter into Azygos Vein: Left or Right Jugular Insertion Has Similar Susceptibility. Blood Purif 2019; 48(1): 1–9.

https://doi.org/10.1159/000497231

5. Keshavamurthy J. Malposition of central lines into azygos vein. Radiopaedia.org. Radiopaedia.org; 2014.

https://doi.org/10.53347/rID-27695

6. Haygood TM, Malhotra K, Ng C, Chasen B, McEnery KW, Chasen M. Migration of central lines from the superior vena cava to the azygous vein. Clin Radiol 2012; 67(1): 49–54.

https://doi.org/10.1016/j.crad.2011.05.011

7. Wang D, Guan Y, Zhuo L, Chen Z, Ma X, Huang Y. Percutaneous transluminal angioplasty is safe and feasible for reinsertion of tunneled cuffed catheters in the right internal jugular vein. Sci Rep 2024; 14(1): 24017.

https://doi.org/10.1177/11297298231223108

8. Xiong Y, Zhao Q, Yu Y, Cui T. A 4-year tunneled hemodialysis catheter malpositioned into the azygos vein and how to remedy the hemodialysis circuit. J Vasc Access 2024; 26(1): 332–335.

https://doi.org/10.1177/11297298231223108

Downloads

Published

30-04-2026

Issue

Section

Case Reports

Categories

How to Cite

1.
Shah MNA, Ahmed F, Baloch BK. Malposition of a Left-Sided Tunneled Hemodialysis Catheter into the Azygos Vein: A Case Report. Pak Armed Forces Med J [Internet]. 2026 Apr. 30 [cited 2026 May 21];76(SUPPL-3):S640-S642. Available from: https://pafmj.org/PAFMJ/article/view/13563