Korean J Anesthesiol.  2014 Jul;67(1):57-60. 10.4097/kjae.2014.67.1.57.

Unusual venous route of pulmonary artery catheter in a liver transplant recipient: pericardiophrenic or highest intercostal vein?: a case report

• Park JH
• Sim KC
• Lee S
• Hwang GS

• KMID: 2236208
• DOI: http://doi.org/10.4097/kjae.2014.67.1.57

Abstract

We report an extraordinary case in which the venous route for pulmonary artery catheterization was unusual. A 41 year-old woman with an end-stage liver disease underwent a living-donor liver transplantation. After induction of anesthesia, the pulmonary artery catheter was revealed to be advanced into the left brachiocephalic vein and then slipped into another vein that drains into the left brachiocephalic vein. In this case, we assumed that the catheter had most likely slipped into the left pericardiophrenic vein since the catheter follows the left heart border similarly to the route of this vein according to the chest X-ray. Patients with liver cirrhosis develop many collateral vessels and have enlarged veins due to portal hypertension, which makes this vascular route possible. We present this case for anesthesiologists to be aware of the possibilities of unusual venous route due to dilated collateral vessels especially in liver transplant patients.

Keyword

Liver cirrhosis; Pulmonary artery catheterization

MeSH Terms

Anesthesia
Brachiocephalic Veins
Catheterization, Swan-Ganz
Catheters*
Female
Heart
Humans
Hypertension, Portal
Liver Cirrhosis
Liver Diseases
Liver Transplantation
Liver*
Pulmonary Artery*
Thorax
Transplantation*
Veins*