VCOM Research Day Program Book 2023

Medical Resident Research Case Reports

19 Persistent Left Superior Vena Cava Case Report: Implications in Central Venous Access and Diagnostic Imaging

1] Dan Strat; 1 Shefali Kanal; 2 Adam Guyer Corresponding author:

1 Lewisgale Medical Center, Department of Graduate Medical Education 2 LewisGale Medical Center, Department of Interventional Radiology

repeated attempts, was found to travel either cephalad or caudal, never crossing midline. There was initial concern for arterial infiltration of the catheter and the procedure was aborted. Patient’s prior chest imaging was immediately reviewed, revealing PLSVC that drained into the coronary sinus. Right upper extremity access was attained without difficulty and the catheter was guided via the right SVC without complication. The patient tolerated the procedure. Discussion: The orientation and caliber of the patient’s PLSVC added difficulty to left brachiocephalic approach, prolonging patient’s operative time, exposure to radiation, and increasing bleed risk due to peripheral access being attained twice. Review, if possible, of patient anatomy with relevant imaging is recommended prior to central venous access procedures to prevent these risks. Review of imaging is especially relevant in the critical care setting, where fluoroscopy guidance is not available, and risks for arrythmia, arterial infiltration, and dissection are greater.

Introduction: Persistent left superior vena cava (PLSVC) is a variant of central venous vasculature with peak incidence of 0.3-0.5%. Its presence has been encountered incidentally on imaging or during procedures across various specialties, and complications have ranged from benign to life threatening due to PLSVC’s spectrum of variations. We report a case in which central venous access was attempted in a patient with previously unknown PLSVC in the interventional radiology suite, leading to complications that increased patient’s radiation exposure, risk to arrythmia and bleeding, and intraoperative time. We also discuss considerations of PLSVC across several specialties, with focus on radiology. Case Report: A 71-year-old Caucasian male with history of cholangiocarcinoma presents to the interventional radiology suite for PICC line placement. Left upper extremity peripheral access was attained and the catheter was visualized under fluoroscopy. When attempting to traverse midline via the left brachiocephalic vein, the catheter tip, with

References Goyral, Sandeep K., et al. “Persistent left superior vena cava: a case report and review of literature.” Cardiovascular ultrasound 6.1 (2008): 1-4 Zhu, Christina, et al. “Beware of a Duplicate Superior Vena Cava.” The Southwest Respiratory and Critical Care Chronicles 10.44 (2022): 48-51


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