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Placement ot central venous catheters has become an increasingly common accompaniment of modern medicine. The frequent need for central pressure monitoring, hyperalimentation, and long-term venous access leads large numbers of patients to undergo this invasive procedure. It is surprising that the incidence of complications is relatively low and that malposition of catheters is rare. This case describes the first English-language report (to our knowledge) of the serendipitous discovery of an anomalous pulmonary venous connection during placement of a jugular catheter. Of particular interest, this anomaly may have contributed, at least in part, to our patients pulmonary hypertension. Case Report A 58-year-old man with a 40 pack-year history of cigarette smoking and ten-year history of asthma was admitted to the hospital foi treatment of acute bronchospasm. He had been treated with theophylline and an inhaled p-agonist and had required hospital admission on three occasions for exacerbations. He had rarely been placed on a regimen of corticosteroids and had never been intubated. On the day of hospital admission he developed severe respiratory distress and he was intubated m the emergency room. On admission the electrocardiogram showed right axis deviation. Echocardiography revealed right ventricular hypertrophy. On the fifth hospital day a pulmonary artery catheter was placed to exclude a diagnosis of cardiogenic pulmonary edema.