Kidney Function

Percutaneous image-guided insertion of a tunneled hemodialysis catheter is a common procedure practiced by interventional nephrologists and radiologists. Among the myriads of reasons for catheter dysfunction presenting as poor flow during dialysis, inadvertent placement of the catheter into the azygos vein is a known, but rare, cause. This malpositioning can be difficult to detect during catheter insertion, as well as on chest radiography, given the subtle clinical and imaging findings. Familiarity with the radiographic features, therefore, is crucial for detection. We hereby illustrate the radiographic features of this malposition.