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Radiographic evaluation of central venous catheter position: anatomic correlation using gated coronary computed

Carole Ann Ridge1, Diana Litmanovich, Francesco Molinari

  • 1Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA. ridgec@mskcc.org

Journal of Thoracic Imaging
|February 22, 2013
PubMed

Insights

The intersection of the bronchus intermedius and right heart border, and the right heart border inflection are the closest radiographic landmarks to the cavoatrial junction (CAJ). The carina is the most consistently visible landmark when others are not identifiable.

Area of Science:

  • Radiology
  • Cardiovascular Imaging
  • Anatomy

Background:

  • Accurate localization of the cavoatrial junction (CAJ) is crucial for procedures involving the right atrium.
  • Identifying reliable radiographic landmarks on computed tomographic angiography (CTA) aids in precise CAJ identification.

Purpose of the Study:

  • To evaluate the best radiographic landmark for the cavoatrial junction (CAJ).
  • To assess landmark visibility and distance from the CAJ using electrocardiographic-gated, 64-row multidetector coronary CTA.

Main Methods:

  • Sixty CTA studies were analyzed by two readers.
  • Radiographic landmarks (carina, bronchus intermedius/right heart border intersection, right heart border inflection) were assessed for visibility and vertical distance from the CAJ.

Main Results:

  • The bronchus intermedius/right heart border intersection (71% visibility) and right heart border inflection (84% visibility) were closest to the CAJ.
  • The carina was visible in 100% of topograms but was further from the CAJ (4.2±1.1 cm).
  • No significant correlation was found between patient demographics and landmark visibility or distance.

Conclusions:

  • The intersection of the bronchus intermedius with the right heart border and the inflection of the right heart border are the most reliable landmarks for the CAJ.
  • The carina serves as a consistently visible alternative when other landmarks are obscured.
Abstract

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