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BJA Advance Access published online on November 25, 2005
British Journal of Anaesthesia, doi:10.1093/bja/aei272
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Accepted October 13, 2005

Case Report

Bedside confirmation of a persistent left superior vena cava based on aberrantly positioned central venous catheter on chest radiograph

N. Ghadiali 1 *, L. M. Teo 1, and K. Sheah 2

1 Department of Anaesthesia and Surgical Intensive Care, Singapore General Hospital, Singapore
2 Department of Diagnostic Radiology, Singapore General Hospital, Singapore

* To whom correspondence should be addressed.
N. Ghadiali, E-mail: nghadiali2003{at}yahoo.com


  Abstract

This is a report of incidental diagnosis of a persistent left superior vena cava (PLSVC) based on an abnormal positioning of central venous catheter seen on chest radiograph and an abnormal pressure waveform. Non-invasive bedside tests included venography with simultaneous chest radiograph and a transthoracic echocardiography with an agitated saline microbubble contrast. These tests led to the diagnosis of PLSVC. Although PLSVC is the most common venous thoracic anomaly that produces a diagnostic dilemma, not many anaesthetists and intensivists are familiar with its appearance, diagnosis and implications. The clinical significance of PLSVC and diagnostic options are discussed.

Keywords: anatomy, abnormal, persistent left sided superior vena cava; measurement techniques, agitated saline test, iodinated contrast; measurement techniques, transthoracic echocardiogram; measurement techniques, venography; monitoring, central venous pressure.
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