1. Radiographic Features of Malpositioning of a Hemodialysis Catheter in the Azygos Vein 
Uei Pua, FRCR 
American Journal of Kidney Diseases 
Volume 55, Issue 2, Pages (February 2010)
DOI: /j.ajkd
Copyright © 2010 National Kidney Foundation, Inc. Terms and Conditions

2. Figure 1
(A) Spot fluoroscopic image shows a gentle kink (black arrow) in the hemodialysis catheter that occurs directly adjacent to the right tracheobronchial angle (black line), which is a constant anatomic landmark that demarcates the path of the trachea and right main bronchus. The tracheobronchial angle marks exactly where the azygos vein opens into the superior vena cava. The presence of a kink at this location indicates that the hemodialysis catheter has entered the azygos vein. Because of the medial course of the azygos vein, the tip of the hemodialysis catheter can be seen crossing the midline spinous processes (white arrow). (B) Frontal chest radiograph of the patient with the hemodialysis catheter within the azygos vein. The mentioned features seen on spot fluoroscopy can be identified. (C) Chest radiograph of another patient with correct hemodialysis catheter placement with the tip in the right atrium.
American Journal of Kidney Diseases  , DOI: ( /j.ajkd )
Copyright © 2010 National Kidney Foundation, Inc. Terms and Conditions

3. Figure 2
(A) Digital subtraction angiogram, obtained by injecting contrast into the venous port, confirms catheter placement in the azygos vein (white arrow). The kink in the catheter is at the ostium of the azygos vein, where it drains into the superior vena cava (black arrow). (B) Spot fluoroscopic image shows the hemodialysis catheter after being redeployed within the right atrium.
American Journal of Kidney Diseases  , DOI: ( /j.ajkd )
Copyright © 2010 National Kidney Foundation, Inc. Terms and Conditions

4. Figure 3
Spot fluoroscopic images of a companion case. The guidewire was inserted after a left internal jugular venous puncture. (A) Guidewire cannulation of the azygos vein shows the characteristic kink (black arrow) at the constant landmark location of the right tracheobronchial angle, similar to Fig 1A. Medial deviation of the guidewire also is seen as it crosses the midline spinous process while following the path of the azygos vein (white arrow). (B) Successful guidewire manipulation into the inferior vena cava shows the absence of a kink at the tracheobronchial angle and the straight vertical path of the guidewire (white arrow). It should be noted that in both instances, the guidewire could be advanced below the level of the diaphragm, showing that this common practice to confirm venous placement cannot be used to exclude azygos vein cannulation.
American Journal of Kidney Diseases  , DOI: ( /j.ajkd )
Copyright © 2010 National Kidney Foundation, Inc. Terms and Conditions