Misplaced Right Internal Jugular Catheter Mimicking the Track of the Left Internal Jugular Catheter

A 59-year-old female with end-stage kidney disease was placed on a temporary double-lumen catheter in the right internal jugular vein (IJV) at the community dialysis center. After encountering a blood flow issue during the third hemodialysis (HD), she was referred to a tertiary care hospital for conversion to a tunneled catheter. An X-ray of the chest revealed an atypical position of the catheter. It was crossing the mediastinum to the left at the level of the carina, almost like a mirror image of the usual left IJV catheter track. The possibilities were congenital anomalies of the right IJV, persistent left superior vena cava, or inadvertent placement in any other vessel. The CT angiogram revealed that the catheter was in the arch of the aorta. The catheter was safely removed without any complications (i.e., bleeding, thrombosis, or embolism). This case demonstrates that if, on an X-ray, right IJV vascular access appears to be crossing the mediastinum to the left, resembling a mirror image of left IJV placement, it may be located in the arch of the aorta. It is likely that the placement was not image-guided, and the backflow check was not interpreted.