Impending catheter perforation of superior vena cava: radiographic recognition

In six of nine patients with superior vena caval perforation by a central venous catheter, the chest radiograph showed a gentle curve at the tip of the catheter 4 hr to 7 days before clinical or radiographic recognition of perforation. This radiographic sign should prompt catheter repositioning to avoid the morbidity and potential mortality associated with superior vena caval perforation.