PMC6823622_01
PMC6823622_02
Echocardiographic evaluation of venous cannula position: (1) superior vena cava; (2) venous cannula; (3) azygos vein; (4) right atrium.
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F1
A new ultrasound showed the venous cannula in the SVC adjacent to the confluence of the brachiocephalic veins with its tip protruding into the azygos vein (Figure 1).
Anteroposterior (A) and lateral (B) chest X-ray: Drainage cannula (12 French) inserted in the jugular vein (a), inflow cannula (8 French) inserted in the carotid artery (b), and cannula tip (c). Even if in (A) the venous cannula seems to have a correct position, lateral chest X-ray reveals that the tip (c) of the venous cannula lies posteriorly to the heart.
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F2
A lateral chest X-ray was also acquired, which revealed that the venous cannula was placed posteriorly to the cardiac silhouette, confirming azygos vein cannulation (Figure 2).
PMC6823622_03
Echocardiography (2D and color Doppler, A, B, respectively) subcostal view, showing the ascending of azygos vein in the posterior mediastinum before entering in the superior vena cava. AZ, Azygos vein; RA, right atrium; SVC, superior vena cava.
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F3
New echocardiography was repeated with confirmation of interruption of the IVC and azygos continuation (Figure 3).
3D-volume rendering reconstructions of Computed Tomography Angiography (CTA) in anterior view (A) and posterior view (B): demonstrating interrupted inferior vena cava with azygos continuation (arrows).
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F4
Computed tomography angiography confirmed the diagnosis of interrupted IVC and azygos continuation as an isolated anomaly (Figure 4).