PMC3169897_01
Plain radiograph of the chest shows the Denver shunt placed in the pleural cavity (arrow) and the venous end directed toward the right internal jugular vein.
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F1
The chest radiograph taken at the Emergency Department shows the venous end of the catheter in the right internal jugular vein [Figure 1a]. A line diagram depicts the normal placement of the Denver pleurovenous shunt and the direction of flow [Figure 1b].
A line diagram of the Denver pleurovenous shunt shows the proximal part of the tube within the pleural cavity and the distal or venous end of the catheter inserted into the internal jugular vein, with its distal end extending to the superior vena cava. The pump within the chest wall allows manual compression and creates a unidirectional flow of fluid from the pleural cavity to the central venous system (arrows).
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F2
Gray-scale ultrasound scan of the neck was performed and the venous end of the catheter was seen within the right internal jugular vein [Figure 2].
Gray-scale ultrasound scan of the right side of the neck shows the venous end of the Denver shunt (arrow) within the right internal jugular vein.
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F3
Pleural end of the catheter was in the right pleural cavity and was detected subcutaneously in the right chest wall, lateral to the sternum [Figure 3].
Ultrasound scan of the right chest wall demonstrates the pleural end of the Denver shunt catheter placed subcutaneously (arrow).
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F4
A septated collection measuring 4.6 cm x 5.6 cm x 3.5 cm was identified anterior to the venous end of the catheter within the soft tissues of the neck as a result of the leaked pleural fluid from the Denver shunt inserted in the internal jugular vein [Figure 4].
Transverse ultrasound scan over the lump on the right side of the neck shows fluid collection measuring 5.5 cm x 3.4 cm anterior to the internal jugular vein. Catheter is seen within the right internal jugular vein (arrow).
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F5
Transabdominal ultrasound scan confirmed the presence of a cirrhotic liver and a significant amount of ascites [Figure 5].