title: Central venous catheter malposition in the azygos vein and difficult endotracheal intubation in severe ankylosing spondylitis: a case report.
abstract: Ankylosing spondylitis (AS) can be challenging for anesthesiologists because central venous access can be difficult, and the airway can be blocked due to the fixed flexion deformity of the spine. In this case, we attempted central access via the right subclavian vein, but the catheter was repeatedly inserted into the azygos vein, which was confirmed by radiology. After several attempts, the catheter position was corrected at the superior vena cava-atrial junction. Although several useful devices have been developed to address difficult intubation, in this case, fiberoptic bronchoscopy was the only applicable safe alternative because of the patient's extremely severe chin on chest deformity and temporomandibular joint disease. We report a successful awake fiberoptic bronchoscopic intubation in a patient with extremely severe AS and recommend that the catheter placement should be confirmed with radiology to ensure proper positioning for severe AS patients.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Graduate School, Kyung Hee University Seoul, Korea.
authors.forename: Eunjin
authors.initials: E
authors.lastname: Moon
authors.affiliation: Department of Anesthesiology and Pain Medicine, Graduate School, Kyung Hee University Seoul, Korea.
authors.forename: Hyungmo
authors.initials: H
authors.lastname: Jeong
authors.affiliation: Department of Anesthesiology and Pain Medicine, Graduate School, Kyung Hee University Seoul, Korea.
authors.forename: Junyoung
authors.initials: J
authors.lastname: Chung
authors.affiliation: Department of Anesthesiology and Pain Medicine, Graduate School, Kyung Hee University Seoul, Korea.
authors.forename: Jaewoo
authors.initials: J
authors.lastname: Yi
keywords: Ankylosing spondylitis; azygos vein; central venous catheters; difficult airway