• Dan Cao, Zhaonan Shen, Qiaoqiao Gui, and Yun He.
• Department of Nephrology, Chongqing Renji Hospital University of Chinese Academy of Sciences, Chongqing, China.
• Medicine (Baltimore). 2020 Apr 1; 99 (15): e19805.

RationaleThe percutaneous catheterization of central veins is widely applied in patients with end-stage renal diseases as a permanent vascular access. To our knowledge, inadvertent placement of a hemodialysis catheter into the azygos vein through the left internal jugular vein is not described.Patient ConcernsA 72-year-old female patient was admitted to the hospital for replacement of another new tunneled hemodialysis catheter due to poor flow in the left internal jugular vein tunneled catheter during hemodialysis.DiagnosisThe catheter tip was incorrectly positioned into the azygos vein as confirmed by conventional anteroposterior and lateral chest radiographs.InterventionsThe catheter was removed and replaced under Digital Subtraction Angiography.OutcomesThe catheter tip was finally placed in the proper position.LessionsThe insertion of central vein catheterization is not always in suitable position especially through left jugular vein in hemodialysis patients. DSA technology should be performed to confirm the correct position of the tip and to ensure good blood flow.

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