Misplacement of the tunnel hemodialysis catheter through the left jugular vein to the azygos vein: A case report

RATIONALE: The percutaneous catheterization of central veins is widely applied in patients with end-stage renal diseases as a permanent vascular access. To our knowledge, inadvertent placement of a hemodialysis catheter into the azygos vein through the left internal jugular vein is not described. PATIENT CONCERNS: A 72-year-old female patient was admitted to the hospital for replacement of another new tunneled hemodialysis catheter due to poor flow in the left internal jugular vein tunneled catheter during hemodialysis. DIAGNOSIS: The catheter tip was incorrectly positioned into the azygos vein as confirmed by conventional anteroposterior and lateral chest radiographs. INTERVENTIONS: The catheter was removed and replaced under Digital Subtraction Angiography. OUTCOMES: The catheter tip was finally placed in the proper position. LESSIONS: The insertion of central vein catheterization is not always in suitable position especially through left jugular vein in hemodialysis patients. DSA technology should be performed to confirm the correct position of the tip and to ensure good blood flow.