title: "Extracaval shepherd's crook" sign: a characteristic radiographic sign of central venous catheter placement in the right internal thoracic vein.
abstract: Inaccurate positioning is a well-known and documented complication of central venous catheterization. Inadvertent placement of a central venous catheter into the right internal thoracic vein has been reported in the literature; however, the characteristic radiographic appearance for this complication has yet to be described. We report 3 cases that demonstrate central venous catheters improperly terminating in the right internal jugular vein. Characteristic radiographic findings of this altered catheter course are described. Recognition of these characteristic findings should prompt consideration for line repositioning or replacement.
authors.affiliation: Department of Radiology, West Virginia University School of Medicine, Morgantown, WV 26506-9235, USA. mtomlin@hsc.wvu.edu
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Tomlin
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Tallaksen
mesh_terms: D000328:Adult; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D020878:Device Removal; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D013902:Radiography, Thoracic; D013909:Thorax / Q000098:blood supply*; D014683:Vena Cava, Superior / Q000000981:diagnostic imaging*