Chest radiograph following replacement of the left upper ext | Figure 1

CincyKidsRad

Cincinnati Children's Radiology

Chest radiograph following replacement of the left upper extremity PICC with a right upper extremity PICC shows the tip of the catheter (arrow) in the right atrium. On the previous image, the catheter remained to the left of the midline and left of the right mainstem bronchus consistent with an arterial location within the aorta. After replacement, the catheter tip is in the venous system. However, it remains in an abnormal location. The expected location of the PICC is in the superior vena cava. On radiograph, this tip should be within two vertebral segments of the carina. #FridayQuizDay #FridayQuiz

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Frontal view of the chest without (image 1) and with (image 2) annotation shows an abnormal course of the left internal jugular port. The distal portion of the port is directed medially and resides within the azygos vein. Normally, the tip of a neck or upper extremity venous catheter should reside within the superior vena cava. Larger catheters may terminate within the right atrium. The azygos vein location is not considered central and, in most cases, should be repositioned.](https://app.figure1.com/case-detail/06d5b1eb-e8f1-4854-9f16-b570339a882d)



Chest radiograph shows an abnormal course of the left upper extremity PICC (arrow). The catheter remains to the left of the trachea with its tip overlying the base of the heart near midline. This course was confirmed to be arterial with contrast injection. A typical upper extremity PICC should reside to the right of the spine overlying the superior vena cava. If the catheter crosses the left mainstem bronchus an arterial location should be considered. An arterial PICC should be removed due to the risk of arterial thrombosis. #ThoraxThursday #ThoracicThursday](https://app.figure1.com/case-detail/26cd8c9a-4a92-4277-acbe-893c12b658ed)



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Where is this catheter located? #FridayQuizDay #FridayQuiz](https://app.figure1.com/case-detail/58c70732-6aa9-45f4-9194-1aee0d8f283f)

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