Central venous catheter malposition into pulmonary vein: an unusual cause of epileptic seizures

Excerpt

A 64-year-old man was admitted to our intensive care unit with acute respiratory failure. A 60-cm femoral central venous catheter (CVC) was inserted to avoid laying the patient down. A right lower atelectasis was seen on a chest X-ray, but the position of the catheter tip was not correctly verified. Twenty-four hours later, he had a seizure. A brain computed tomography (CT) angiography was performed. Intravenous contrast was injected through the femoral catheter and appeared directly in the left atrium (LA) (Fig. 1a). A thoracic CT showed an anomalous bend of the CVC (Fig. 1b) with the tip in the right lower pulmonary vein (Fig. 1c). Transesophageal echocardiography confirmed the entry of the catheter into the LA through the foramen ovale (Fig. 1d) with a thrombus attached to it and floating inside (Video 1). Anticoagulation was started and a new CT scan showed an ischemic stroke.

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