"It Looks Arterial": The Chest X-Ray of Nightmares

Central venous access is a common procedure for a variety of indications such as dialysis, plasmapheresis, or difficult venous access. Although a relatively safe procedure that can be done at the bedside, complications can still occur. Recognition and management of central line complications such as vascular injury and bleeding, infection, and misplacement are important when caring for patients with central vascular access and for the proceduralist who places the central line. Here we present an uncommon complication of internal jugular central access where a left internal jugular central line placement resulted in misplacement of the line in the hemiazygos vein.