Radiographic imaging of an intra-aortic balloon pump impersonating a misplacement in the superior vena cava due to a right-sided aortic arch

Description

A 48-year-old man with a history of coronary heart disease underwent a left heart catheterisation for non-ST-segment myocardial infarction. Coronary angiography revealed significant stenosis of the left anterior descending artery and right coronary artery (LAD/RCA). Transthoracic echocardiogram showed severely dilated left ventricle (LV), moderate concentric LV hypertrophy, an LV ejection fraction of 26% and elevated right ventricular systolic pressure of 40–45 mm Hg. An intra-aortic balloon pump (IABP) was placed for haemodynamic support through a right femoral artery insertion site. The patient later received a saphenous vein graft (SVG) to the RCA, an SVG to the left obtuse marginal artery and a left internal mammary artery graft to the LAD. On the postoperative chest X-ray, the IABP was visualised overlying the right hilar region, thatevoked alarming concern of possible misinsertion into the superior vena cava (SVC) through an arteriovenous fistula or through the femoral vein (figure 1). Delayed...

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