title: Accidental catheterization of epidural venous plexus: tomographic analysis.
abstract: OBJECTIVE
  Inadvertent venous catheterizations occur in approximately 9% of lumbar epidural anesthetic procedures with catheter placement and, if not promptly recognized, can result in fatal consequences. The objective of this report is to describe a case of accidental catheterization of epidural venous plexus and its recording by computed tomography with contrast injection through the catheter.
  
  
  METHODS
  A female patient in her sixties, physical status II (ASA), underwent conventional cholecystectomy under balanced general anesthesia and an epidural with catheter for postoperative analgesia. During surgery, there was clinical suspicion of accidental catheterization of epidural venous plexus because of blood backflow through the catheter, confirmed by the administration of a test dose through the catheter. After the surgery, a CT scan was obtained after contrast injection through the catheter. Contrast was observed all the way from the skin to the azygos vein, passing through anterior and posterior epidural venous plexuses and intervertebral vein.
  
  
  CONCLUSIONS
  It is possible to identify the actual placement of the epidural catheter, as well as to register an accidental catheterization of the epidural venous plexus, using computed tomography with contrast injection through the epidural catheter.
authors.affiliation: Hospital Regional do Gama (HRG), Brasília, DF, Brazil. Electronic address: dr-marianosouza@gmail.com.
authors.forename: Mariano Paiva
authors.initials: MP
authors.lastname: Souza
authors.affiliation: Universidade de Brasília (UnB), Brasília, DF, Brazil; Scientific Department, Sociedade Brasileira de Anestesiologia, Brasília, DF, Brazil.
authors.forename: Edno
authors.initials: E
authors.lastname: Magalhães
authors.affiliation: Hospital Regional do Gama (HRG), Brasília, DF, Brazil.
authors.forename: Elialba
authors.initials: E
authors.lastname: de Farias Cascudo
authors.affiliation: Hospital Regional do Gama (HRG), Brasília, DF, Brazil.
authors.forename: Marco Antonio Dias
authors.initials: MA
authors.lastname: Jogaib
authors.affiliation: Hospital Regional do Gama (HRG), Brasília, DF, Brazil.
authors.forename: Marcelo Carneiro
authors.initials: MC
authors.lastname: da Silva
mesh_terms: D000767:Anesthesia, Epidural / Q000379:methods; D000768:Anesthesia, General / Q000379:methods; D002404:Catheterization / Q000009:adverse effects* / Q000379:methods; D002763:Cholecystectomy / Q000379:methods; D003287:Contrast Media / Q000008:administration & dosage; D004824:Epidural Space / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media
keywords: Anestesia: peridural; Anesthesia: epidural anesthesia; Azygos vein; Cateter peridural; Complications: venous catheterization; Complicações: cateterização venosa; Epidural catheter; Intervertebral vein; Tomografia: plexo venoso; Tomography: venous plexus; Veia intervertebral; Veia ázigo