An anteromedial internal jugular vein successfully cannulated using the assistance of ultrasonography.

The internal jugular vein usually is found either lateral or anterolateral to the carotid artery when it is cannulated for central vein access using external anatomical landmarks. We report a case in which the carotid artery was inadvertently punctured, but the right internal jugular vein could not be found. We used ultrasonic guidance to determine that the right internal jugular vein was anteromedial to the carotid artery. A figure showing the ultrasound of this rare anatomical variation is provided. The advantages and utility of ultrasound when used for the placement of internal jugular central vein catheters are reviewed.