We describe a case of late perforation of the superior vena cava by a
hemodialysis catheter inserted via the left internal jugular vein. Thi
s resulted in extravasation of blood. Malposition of the catheter was
confirmed by CT scan. Removal of the catheter resulted in rapid resolu
tion of symptoms. Confirmation of correct placement of central venous
catheter must be obtained by chest X-ray contrast study.