Migration of peripherally inserted central catheter likely into the azygos vein: a conservative management.

To cite: Talari G, OyewoleEletu S, Talari P, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2016216657 DESCRIPTION A 31-year-old female patient with systolic heart failure (ejection fraction of 30%) and automatic implantable cardioverter-defibrillator (AICD) was admitted to the hospital with sepsis from Staphylococcus hominis and Staphylococcus capitis bacteraemia. A transesophageal echocardiogram showed AICD lead vegetation. Subsequently, the AICD was replaced. A peripherally inserted central catheter (PICC) was placed through the left basilic vein due to difficult intravenous access. Initially, fluoroscopy (figure 1) and chest X-ray (figure 2) confirmed appropriate position of the catheter tip in the superior vena cava (SVC). A day after placement, the PICC line stopped functioning. A repeat chest X-ray (figure 3) at this time revealed the catheter tip going likely dorsally over the right main stem bronchus. The official radiology report stated that the PICC line is in azygos vein (AV). We discussed these findings with two different expert radiologists at our university hospital and concluded that PICC tip was likely in the AV and kinked. We forcefully flushed the line for 10 s with