Figure 2: CT thorax without contrast shows catheter (arrow) deep to the clavicle (top) and coiled in the right heart heart (bottom).
jugular vein, whichmay occur when the catheter is tunneled too deep. The other proposed mechanism was erosion into an adjacent vein by the distal catheter. Once the portion of the catheter is in lumen of the vessel, the same described mechanismof inspiratory pressure coupledwith blood flow draws the catheter proximally to the heart. The diagnosis is easily made with plain films, as in our case, but the surgeon should obtain further imaging for complete operative planning. CT scanning of the neck and
chest will reveal the vessel in which the catheter travels, as well as the specific course within the chest cavity. An echocardiogram will show the exact location in the heart, and it will also help rule out thrombus, cardiac perforation, valvular damage, or tamponade. Cardiac rhythmmonitor- ing or an electrocardiogram will show any ectopy if there is a focus due to the catheter. A review of the literature shows an evolution in the treatment for this specific problem. The patient in the first
J La State Med Soc VOL 166 January/February 2014 23
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