title: Radiographic evaluation of central venous catheter position: anatomic correlation using gated coronary computed tomographic angiography.
abstract: OBJECTIVE
  To determine the best radiographic landmark for the cavoatrial junction (CAJ) using electrocardiographic-gated, 64-row multidetector coronary computed tomographic angiography (CTA).
  
  
  METHODS
  Institutional Review Board approval was obtained. Patient age, sex, weight, and height were recorded. The CAJ was localized by 2 readers using multiplanar CTA, cross-referenced with a scout topogram. Designated radiographic landmarks (the carina, intersection between the bronchus intermedius and the right heart border, and the inflection of the right heart border) were assessed for visibility and vertical distance from the CAJ.
  
  
  RESULTS
  Sixty consecutive CTA studies (39 men, 21 women; age range, 27 to 98 y; mean±SD, 55±15 y) were analyzed. The closest radiographic landmark to the CAJ was the intersection between the bronchus intermedius and the right heart border (0.9±0.8 cm above the CAJ), visible in 71% of patients. The second closest radiographic landmark was the inflection of the right heart border (1±0.8 cm above the CAJ), visible in 84% of patients. The carina was visible on 100% of topograms, 4.2±1.1 cm above the CAJ. There was no strong correlation between age, weight, height, or sex and the visibility or distance of landmarks from the CAJ.
  
  
  CONCLUSIONS
  The intersection of the bronchus intermedius with the right heart border and the inflection of the right heart border are the closest radiographic landmarks to the CAJ. When these landmarks are not identifiable, the most uniformly visible radiographic landmark is the carina.
authors: Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA. ridgec@mskcc.org
authors: Carole Ann
authors: CA
authors: Ridge
authors: Diana
authors: D
authors: Litmanovich
authors: Francesco
authors: F
authors: Molinari
authors: Alexander A
authors: AA
authors: Bankier
authors: Ronald L
authors: RL
authors: Eisenberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055424:Cardiac-Gated Imaging Techniques; D002405:Catheterization, Central Venous / Q000379:methods*; D062905:Central Venous Catheters; D017023:Coronary Angiography / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D006325:Heart Atria / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional; D014057:Tomography, X-Ray Computed; D014684:Venae Cavae / Q000033:anatomy & histology / Q000000981:diagnostic imaging*