Radiologic Assessment of Malpositioned Indwelling Catheters and Medical Devices: A Retrospective Case Series With Pictorial Review.

backgroundIndwelling medical devices such as central venous catheters (CVCs), ureteral stents, ventriculoperitoneal (VP) shunts, inferior vena cava (IVC) filters, percutaneous endoscopic gastrostomy (PEG) tubes, and nasogastric (NG) tubes are integral to modern clinical care. Malposition or migration, however, can result in severe complications, including vascular injury, organ perforation, infection, and obstruction. Radiologists are often the first to detect these complications, but interpretation may be challenging due to variable device types, insertion techniques, and patient anatomy.

methodsWe conducted a retrospective case-based review of malpositioned indwelling devices encountered in clinical practice at our institution. Each case was analyzed individually with attention to device type, insertion pathway, radiographic landmarks, abnormal positioning patterns, and associated complications. Representative examples were selected to create a pictorial review highlighting imaging pearls and diagnostic pitfalls.

resultsThe cases illustrate a wide spectrum of malposition patterns across commonly placed devices. Vascular access complications included arterial cannulation, aberrant venous placement, and migration into unexpected vascular channels. Ureteral stent malpositions demonstrated distal migration into the urethra and proximal perforation through the renal cortex. VP shunt cases showed distal extrusion into hollow viscera such as the rectum. IVC filter malpositions included tilt, strut perforation, and extension into adjacent organs. PEG tube malpositions resulted in intraperitoneal leakage and peritonitis, while NG tube misplacements involved tracheobronchial insertion and gastric perforation. These examples highlight both typical and rare presentations, underscoring the importance of systematic radiographic evaluation.

conclusionThis retrospective case series and pictorial review underscore the critical role of radiologists in recognizing malpositioned indwelling devices. Accurate interpretation requires a structured imaging approach, correlation with clinical context, and familiarity with device-specific pitfalls. By presenting illustrative examples across multiple device types, this work provides a practical reference to enhance radiologic vigilance, improve diagnostic accuracy, and ultimately prevent adverse outcomes in patients with indwelling catheters and medical devices.