Echocardiography-Guided Management of a Dialysis Catheter Complication: A Case Report

The right internal jugular vein is the standard route for central venous catheterization.However, anatomical anomalies such as masses may necessitate alternative access.In this case, catheter placement via the left internal jugular vein was required due to compression of the right jugular vein by a thyroid mass.Following insertion, the absence of blood return raised concerns regarding malposition.While chest X-ray and computed tomography were inconclusive in identifying the catheter tip location, definitive confirmation was achieved through echocardiographic evaluation.Transesophageal echocardiography (TEE) with agitated saline accurately revealed extravascular placement within the pleural space.Subsequently, the catheter was safely removed under transthoracic echocardiographic guidance without complications.This case underscores the superior diagnostic accuracy and procedural guidance offered by echocardiography-particularly TEE-over conventional imaging modalities in the detection and management of catheter-related complications.