Korean J Crit Care Med.  2016 May;31(2):152-155. 10.4266/kjccm.2016.31.2.152.

Extracorporeal Membrane Oxygenation Cannula Malposition in the Azygos Vein in a Neonate with Right-Sided Congenital Diaphragmatic Hernia

  • 1Division of Pediatric Critical Care Medicine, Asan Medical Center Children's Hospital, Seoul, Korea. drpsj@amc.seoul.kr
  • 2Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.


Malposition of the extracorporeal membrane oxygenation (ECMO) venous cannula in the azygos vein is not frequently reported. We hereby present such a case, which occurred in a neonate with right-sided congenital diaphragmatic hernia. Despite ECMO application, neither adequate flow nor sufficient oxygenation was achieved. On the cross-table lateral chest radiograph, the cannula tip was identified posterior to the heart silhouette, which implied malposition of the cannula in the azygos vein. After repositioning the cannula, the target flow and oxygenation were successfully achieved. When sufficient venous flow is not achieved, as in our case, clinicians should be alerted so they can identify the cannula tip location on lateral chest radiograph and confirm whether malposition in the azygos vein is the cause of the ineffective ECMO.


azygos vein; congenital diaphragmatic hernia; extracorporeal membrane oxygenation; neonate

MeSH Terms

Azygos Vein*
Extracorporeal Membrane Oxygenation*
Hernias, Diaphragmatic, Congenital*
Infant, Newborn*
Radiography, Thoracic


  • Fig. 1. Antero-posterior chest radiograph after admission. Typical findings of right-sided CDH is noticed – bowel gas is present on the right lung field, and the heart and mediastinum are deviated to the left. CDH: congenital diaphragmatic hernia.

  • Fig. 2. Antero-posterior chest radiograph after ECMO cannulation. Total lung haziness is noticed due to ARDS and combined heart failure, thereby obliterating the cardiac silhouette. ECMO: extracorporeal membrane oxygenation; ARDS: acute respiratory distress syndrome; VC: venous cannula; AC: arterial cannula.

  • Fig. 3. Cross-table lateral chest radiographs showing the cannula tip positioned posterior to the cardiac silhouette (A), and anterior in the superior vena cava after adjustment (B).

Cited by  1 articles

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Ji Young Lee
Korean J Crit Care Med. 2016;31(2):73-75.    doi: 10.4266/kjccm.2016.31.2.73.



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