What is the most likely diagnosis?

• 51 year-old with newly inserted central line

Frontal Chest Radiograph

1. Placement in Superior Vena Cava
2. Placement in Internal Jugular vein
3. Placement in Azygous Vein
4. Post-placement Pneumothorax
5. Arterial Placement

Additional Image - Close-up image of Chest Radiograph

 

Additional Images

 

Close-up of Chest Radiograph

Answer:

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5. Arterial Placement

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Arterial Placement of Central Line

General Considerations

• Percutaneous cannulation of a central venous structure is a common procedure, most often for fluid replacement, administration of medication, for parenteral alimentation
• Arterial puncture has been reported in 5.2% of attempted central venous catheter (CVC) insertions
• Pneumothorax is the most common complication of central venous catheter insertion attempts
• Puncture of the artery (carotid) is more likely to occur in an attempted internal jugular approach than a subclavian vein approach for the subclavian artery
• Frequency of a mechanical complication increases six-fold when three or more attempts are made
• Arterial cannulation may occur if the subclavian puncture is too lateral or too deep

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