A term newborn with a provisional diagnosis of persistent pulmonary hypertension of the newborn was admitted to our Intensive Care Unit, with an impending cardio-respiratory failure. The child was intubated, ventilated and started on inhaled nitric oxide. A right internal jugular vein was cannulated for central venous pressure monitoring/possible inotropic use.
As the colour of the blood was bright (blood gases done showed an arterial picture), a repeat echocardiography was performed to rule out the presence of anomalous pulmonary venous drainage into superior vena cava. Repeat echocardiography did not reveal any abnormality of the pulmonary venous drainage but confirmed the presence of the cannula in the superior vena cava.
Incidentally when the echo probe was placed on the anterior fontanel, a large midline venous structure was seen. A head ultrasound showed the same. Magnetic resonance imaging confirmed the vein of Galen malformation.