Fig. 1.
Computed tomography scan showing a left internal jugular central venous catheter ending in the anomalous left superior pulmonary vein.

Computed tomography scan showing a left internal jugular central venous catheter ending in the anomalous left superior pulmonary vein.

Pulmonary venous anatomy comprises of four veins: right and left superior and inferior veins which individually drain into the left atrium. Partial anomalous pulmonary venous return may result in blood draining into any of the central veins. It is present in 0.4 to 0.7% of individuals and can be associated with atrial septal defects.  Left sided partial anomalous pulmonary venous return is uncommon.  In left sided partial anomalous pulmonary venous return, the left pulmonary veins often drain into an anomalous vein that drains into the innominate vein (fig. 2).

Fig. 2.
Artist’s rendition of the pathway of the central venous catheter from the left internal jugular vein into the anomalous left superior pulmonary vein. LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle. Artist: Shruthi S Gupta.

Artist’s rendition of the pathway of the central venous catheter from the left internal jugular vein into the anomalous left superior pulmonary vein. LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle. Artist: Shruthi S Gupta.

If a catheter placed in the left internal jugular courses down and into the left or right lung hilum, a high degree of suspicion should exist for partial anomalous pulmonary venous return. Ideally the catheter should be promptly removed to prevent catheter related blood clots, pulmonary emboli and strokes.  If the catheter is needed, an air bubble filter use would be prudent.

Sending simultaneous blood samples from the misplaced central and other confirmed central, arterial catheters may aid in the diagnosis of partial anomalous pulmonary venous return. In a situation where the left internal jugular is the only central venous access available, the central line can be placed or repositioned under fluoroscopic guidance. In our patient the catheter was never used and removed after the computed tomography scan results were reported. The central line was subsequently replaced under fluoroscopy.