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Case of an Incidental Finding of a Persistent Left Superior Vena Cava Discovered After Placement of Central Venous Catheter FREE TO VIEW

Brendon Colaco, MD; Saba Saleem, MD; Clinton Colaco, MD; Mohammad Siddiqui, MD
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University of Arkansas for Medical Sciences, Little Rock, AR

Chest. 2013;144(4_MeetingAbstracts):292A. doi:10.1378/chest.1704971
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SESSION TITLE: Critical Care Case Report Posters II

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM

INTRODUCTION: A persistent left superior vena cava (PLSVC) is seen in 0.3% of healthy population and 4.4% of persons with cardiac disease. The PLSVC may be present during early fetal life but usually attenuates and absorbs with development. Sometimes persistence of the left anterior cardinal vein results in a PLSVC. 82 % of PLSVC co-exist with a right superior vena cava and so this anomaly is often missed as central venous catheters (CVL) are more commonly inserted on the right side (1).

CASE PRESENTATION: 58 year old patient with a history of congestive heart failure (CHF) with an ejection fraction of 15-20%, Atrial Fibrillation (A Fib), with an automated implantable cardioverter-defibrillator placed in right chest, Stage 3 chronic kidney disease and diabetes was admitted with CHF exacerbation and had successful diuresis awaiting discharge. Patient went into Ventricular tachycardia followed by Pulseless electrical activity (PEA) after placement of a nasogastric tube for abdominal distension. Following resuscitation a central venous line was placed at bedside with ultrasound guidance. Chest Xray post placement of the line revealed a PLSVC. The central venous line on the left in the PLSVC was able to draw blood and administer fluids and medication.

DISCUSSION: PLSVC can cause difficult left-sided central line insertion of catheters, pulmonary artery catheters or pacing wire. Also, the abnormal catheter position on post insertion chest radiograph may be mistaken for arterial or extravascular placement if the operator does not bear the possibility of aberrance in mind. Checking the venous waveform is one way of confirming the placement of the line in a PLSVC. Finally prior placement of right sided pacemakers/AICD’s in these patients who are prone to cardiac arrhythmias arouse suspicion of a PLSVC. In addition these patients may present with cardiac arrhythmias in the absence of typical etiologies precipitating a code.

CONCLUSIONS: Our patient with prior AICD, had successful placement of a CVL in PLSVC status post PEA following ventricular tachycardia with underlying CHF and A Fib.

Reference #1: Ghadiali N et al. 2006 Bedside confirmation of a persistent left superior vena cava based on aberrantly positioned central venous catheter on chest radiograph,. Br. J. Anaesth. (January 2006) 96 (1): 53-56.

DISCLOSURE: The following authors have nothing to disclose: Brendon Colaco, Saba Saleem, Clinton Colaco, Mohammad Siddiqui

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