Pediatr Radiol. 2008 Mar;38(3):331-5. Epub 2007 Nov 20.

The bowed catheter sign: a risk for pericardial tamponade.

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Department of Radiology, Phoenix Children's Hospital, 1919 E. Thomas Road, Phoenix, AZ 85016, USA. rtowbin@phoenixchildrens.com

Abstract

The use of a central venous catheter (CVC) has become commonplace in the care of children with a wide variety of medical and surgical problems. Complications resulting from the insertion of these catheters are well recognized and can be life-threatening. When a temporary CVC or other catheter is inserted into the central venous system it is secured to the skin with a combination of sutures and sterile dressing. This fixes the catheter in place and does not allow it to retract, thereby putting pressure on the right atrial wall via the catheter tip if it is too long. The probability of wall penetration is increased if a catheter or device is tapered at the point of contact. The purpose of this case report is to present the bowed catheter sign and to review the anatomy of the cavotricuspid isthmus, a possible predisposing factor to cardiac perforation and tamponade.

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