UNLABELLED: Ultrasound is the standard procedure for central venous catheterization, but despite its use, malposition of the catheter tip can still occur. We are reporting a case where the catheter tip was malpositioned into the left lower pulmonary vein in a patient with a total anomalous pulmonary venous connection. It is crucial to maintain a high index of clinical suspicion to promptly identify and manage malpositioned catheters. Once identified, it is important to decide on whether to retain or redirect the catheter with the appropriate clinical context. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12055-024-01817-3.