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Persistent Left Superior Vena Cava: Clinical Implications for Central Venous Cannulation

Wolfram Schummer, MD^*
Claudia Schummer, MD^*
Eva Hoffmann, MD
Matthias Gerold, MD

^* Clinic for Anesthesiology and Intensive Care Medicine and Department of Internal Medicine IV, (Nephrology, Rheumatology, Osteology, Pneumology), Friedrich-Schiller-University of Jena, Germany; and Clinic for Anesthesiology and Intensive Care Medicine, Hospital DRK Westend Berlin, Germany

Correspondence: Correspondence: Wolfram Schummer, MD, Clinic for Anesthesia and Intensive Care Medicine, Friedrich-Schiller University, Bachstrasse 18, 07743 Jena, Germany. Electronic mail may be sent to cwsm.schummer{at}gmx.de.

In general, persistence of the left superior vena cava (LSVC), the most common anomaly of the venous circulation, is asymptomatic. Diagnosis of a catheter in a persistent LSVC is not straight forward, and a LSVC can create difficulties during central venous and pulmonary artery catheterization. We discuss the differential diagnosis of left-sided central venous catheters (CVC). Finally a directive is given to prevent dilator-induced vessel injuries. We report the cannulation of an unsuspected persistent LSVC in two patients. A dilator-induced vessel injury contributed significantly to the fatal outcome in the first case. On a plain chest X-ray, a catheter in a LSVC will run down the left mediastinal border and can be confused with other intravascular malpositions and extravascular malpositions. Contrast-enhanced lateral chest radiograph is an inexpensive and readily available method that can be used to determine exact position.

Nutrition in Clinical Practice, Vol. 17, No. 5, 304-308 (2002)
DOI: 10.1177/0115426502017005304


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