Inadvertent placement of tunneled hemodialysis catheter in persistent left superior vena cava

Abstract

Persistent left superior vena cava (PLSVC) is the most common congenital intrathoracic venous anomaly with significant clinical relevance. In the vast majority of cases, it is asymptomatic and diagnosed after noticing an abnormal course of central venous access device on a routine post-procedure roentgenogram. It may also be accidentally discovered after facing difficulty in accessing the right side of the heart from a left internal jugular vein or left subclavian vein approach, a common site of access while placing cardiac pacemaker and Swan-Ganz catheter, or after a complication associated with hemodialysis (HD) catheter insertion. HD through a catheter in PLSVC has its own set of pitfalls and should be reserved for short-term dialysis at the best. In this case report, we present a scenario where PLSVC was discovered after the placement of a tunneled HD catheter.