A rare cause of abdominal pain: Catheter in the middle hepatic vein

Abstract

Hemodialysis catheters are vital for chronic renal failure patients. Permanent tunneled dialysis catheters may be inserted through the jugular, subclavian, and femoral veins. In this paper, we aimed to present the computed tomography findings of a chronic renal failure patient who had referred our clinic with abdominal pain and dyspnea symptoms. This patient had a formerly inserted hemodialysis catheter for chronic renal failure and her catheter was found to be extending towards the middle hepatic vein with the tip leaning onto the parenchyma. Hemodialysis catheters can provide instant vascular access and can also be used for the consecutive procedures. Permanent hemodialysis catheters are ideal for long-term use when placing an arteriovenous fistula is contraindicated or is no longer possible under conditions like advanced heart failure, peripheral artery disease or short life expectancy. The internal jugular, subclavian, the femoral veins, and the inferior vena cava can be used for catheter insertion. The tip of the catheters inserted in the neck or the thorax must extend to the vena cava superior. Catheter malposition may both lead to fatal outcomes and ineffective dialysis. It is important to obtain chest X-rays after the procedure, particularly to detect catheter malposition.

One patient, two malpositioned hemodialysis catheters, (hepatic vein and ascending lumbar vein), no fluoroscopy

“…7 However, complications such as malposition and dysfunction have been reported after catheterization through FV. [3][4][5] In our case as well, malposition developed in both catheter interventions, and late diagnosis could be made since no evaluation was made with fluoroscopy or x-ray immediately after the procedure.…”

“…The NKF‐DOQI clinical practice guidelines recommend routine chest x‐ray to detect potential complications and to confirm the placement of the catheter after jugular and subclavian catheter insertion 7 . However, complications such as malposition and dysfunction have been reported after catheterization through FV 3–5 . In our case as well, malposition developed in both catheter interventions, and late diagnosis could be made since no evaluation was made with fluoroscopy or x‐ray immediately after the procedure.…”

“…Hepatic vein malposition and related complications after CTHC application have previously been reported 3,4 . However, CTHC inserted into the ALV via FV is a rarer malposition 5,8 .…”

“…Hepatic vein malposition and related complications after CTHC application have previously been reported. 3,4 However, CTHC inserted into the ALV via FV is a rarer malposition. 5,8 As in our case, the possibility of malposition of the catheter to the ALV is higher in interventions performed through the left FV, due to the wider angle between the left ALV and CIV.…”

“…1 In addition, complications such as infection, thrombosis, arrhythmia, entrapped guide wire and malposition may occur during and/or after the procedure. 2,3 The insertion of the hemodialysis catheter tip into the hepatic veins is a very rare condition 4 ; yet, the insertion of the hemodialysis catheter tip into the ascending lumbar vein (ALV) is a rarer condition. 5 Placement of CTHC first in the hepatic vein and then in the left ALV at the next attempt in the same patient is a much rarer situation.…”