title: Unusual venous route of pulmonary artery catheter in a liver transplant recipient: pericardiophrenic or highest intercostal vein?: a case report.
abstract: We report an extraordinary case in which the venous route for pulmonary artery catheterization was unusual. A 41 year-old woman with an end-stage liver disease underwent a living-donor liver transplantation. After induction of anesthesia, the pulmonary artery catheter was revealed to be advanced into the left brachiocephalic vein and then slipped into another vein that drains into the left brachiocephalic vein. In this case, we assumed that the catheter had most likely slipped into the left pericardiophrenic vein since the catheter follows the left heart border similarly to the route of this vein according to the chest X-ray. Patients with liver cirrhosis develop many collateral vessels and have enlarged veins due to portal hypertension, which makes this vascular route possible. We present this case for anesthesiologists to be aware of the possibilities of unusual venous route due to dilated collateral vessels especially in liver transplant patients.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Ji Hyun
authors.initials: JH
authors.lastname: Park
authors.affiliation: Department of Radiology, Korea University College of Medicine, Anam Hospital, Seoul, Korea.
authors.forename: Ki Choon
authors.initials: KC
authors.lastname: Sim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Sooho
authors.initials: S
authors.lastname: Lee
authors.affiliation: Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Gyu-Sam
authors.initials: GS
authors.lastname: Hwang
keywords: Liver cirrhosis; Pulmonary artery catheterization
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