A patient underwent CRRT throw a left femoral vein catheter (34cm–13.5F). Immediately after the insertion we detected problems in the circuit blood flow and the patient deteriorated. A CT scan showed the tip of the catheter in the left lumbar vein beside a retroperitoneal haematoma (Fig. 1). Another patient (same catheter and insertion technique) showed persistent blood flow problems and in a CT scan the catheter was detected in an accessory left hemiacygos vein and already visible in the plain abdominal X-ray (Fig. 2). Because presumably an eco-directed insertion would not have prevented these anomalous locations, in the event of serious flow problems, a radiologic exploration can help ruling out this unusual and scarcely reported malposition that demands immediate withdrawal of the catheter.

Figure 1

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Figure 2

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