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This revealed moderate pulmonary hypertension (68/44 mm Hg with pulmonary capillary wedge pressure of 10 mm Hg), a mixed venous oxygen saturation of 80 percent, and a thermodilution cardiac output of 9 L/min consistent with evolving Pseudomonas sepsis. A complicated and stormy course followed, with myocardial infarction, refractory bacterial and candidal sepsis, massive gastrointestinal hemorrhage, and acute renal failure. On the 39th hospital day a venous introducer sheath and venous catheter were percutaneously placed through the left internal jugular vein without difficulty. A pressure tracing from the tip of the catheter is shown in Figure 1, and this led to concern about the catheters position. The patient was being mechanically ventilated and was on an inspired oxygen fraction of 0.6. Blood from the side arm of the introducer sheath, from the tip of the catheter, and from an arterial line were sent for analysis of blood gases as follows: Po,    Pco2    pH Introducer sheath:    73    53    7.31 Catheter tip:    307    33    7.50 Arterial line:    70    50    7.37 A posteroanterior and lateral chest roentgenogram showed the tip of the catheter to be within the left lung in three dimensions (Fig 2). Injection of intravenous contrast was performed to confirm the position of the catheter and showed filling of an anomalous pulmonary vein. This large vein drained into the left brachiocephalic vein just as it was joined superiorly by the jugular vein. Our catheter has passed down the jugular vein and directly into the anomalous vein. Under fluoroscopic guidance the catheter was redirected over a wire into the superior vena cava. Eventually the patient died secondary to multiple organ failure and sepsis. An autopsy was not performed. Figure 1. Pressure tracing from the tip of the catheter shown with a simultaneous electrocardiographic recording. The pulsatile nature of the pressure is typical of a pulmonary venous wedge tracing. Pressures are in millimeters of mercury. Figure 2 (left). Anteroposterior roentgenogram of the chest demonstrating the catheter positioned over the left hemithorax. Figure 2b (tight). Lateral view of the chest proving that the catheter tip is within the lung.