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Case Overview:

A 54 year old woman was diagnosed with large B-cell lymphoma and the chemotherapy required repeated access to her venous system. She was scheduled to have a catheter port placed in her left subclavian vein. The attempts through the subclavian vein were unsuccessful so the physician switched to the left internal jugular vein. During fluoroscopy the physician saw that the catheter was placed towards the patient’s left in the azygos vein. The physician removed the catheter and inserted the catheter into the superior vena cava, but the patient became hypotensive, had a drop in blood pressure, and she went into cardiopulmonary arrest. An echo showed that there was a large pericardial effusion. A sternotomy, opening of the chest, was performed and the pericardium was opened. A hematoma was removed and a hole in the left pulmonary artery was discovered and repaired. The jury found in favor of the defense.