Left-sided superior vena cava: a not-so-unusual vascular anomaly discovered during central venous and pulmonary artery catheterization.

Overview

OBJECTIVE: To report our ICU experience with patients noted to have a left-sided superior vena cava after central venous and pulmonary artery catheterization. DESIGN: Retrospective review. SETTING: Surgical ICUs in a University and Veterans Administration Medical Center. PATIENTS: Five patients who had insertion of central venous or pulmonary artery catheters were noted to have abnormal placement. RESULTS: Five patients were noted to have a left-sided superior vena cava that was not appreciated on preinsertion radiography after central venous (two patients) or pulmonary artery catheterization (three patients). The finding of left-sided superior vena cava was confirmed by computed tomography scan (one patient), transesophageal echocardiography (one patient), bolus contrast injection (two patients), and intraoperative inspection (one patient). CONCLUSIONS: Left-sided superior vena cava occurs infrequently, most often in association with a right-sided superior vena cava. It is often associated with cardiac septal defects. The intensivist should be aware of its occurrence in order to not mistake catheters placed in it as being present in the arterial circulation or malpositioned outside of the venous circulation.