INCIDENTAL DISCOVERY OF ISOLATED LEFT SUPERIOR VENA CAVA ALONG WITH ABSENCE OF RIGHT SUPERIOR VENA CAVA DURING HEMODIALYSIS CATHETER PLACEMENT: A CASE REPORT

Introduction:

Hemodialysis remains the most widely used form of kidney replacement therapy. The insertion of a Central Venous Catheter (CVC) is the most frequent medical procedure performed when a patient begins hemodialysis treatment.A left superior vena cava (SVC) is a rare anatomical variation, occurring in around 0.3-0.5% of the population. Conversely, it is more prevalent among those with congenital heart disease, affecting 4.3% of cases. Typically, patients with left SVC also have a right SVC. However, the exceptional combination of persistent left SVC and absent right SVC occurs in a mere 0.09% to 0.13% of patients with congenital heart defects.

Methods:

A 30-year-old male with a history of renal insufficiency and hypertension was admitted to the ward for initiation of hemodialysis via a right internal jugular non-tunneled HD catheter (Avro 11.5 Fr 13cm). The right internal jugular vein HD catheterization was performed under ultrasound guidance and local anesthesia, with all aseptic precautions taken, in the day care procedure room. The procedure was uneventful.Post-HD catheterization protocol included a chest X-ray to confirm catheter tip position, which surprisingly revealed the right jugular catheter with its distal end in the mediastinum on the left.

Results:

The patient was immediately taken to the Cath lab for further evaluation. Under fluoroscopy guidance, it was suspected that the catheter was in a persistent left superior vena cava (PLSVC).Despite manipulation of the catheter over a guide wire, it could not be passed through the right SVC. This suggested the possibility of an isolated left SVC with absent right SVC, which was confirmed by neck vessels CT angiography.The patient underwent hemodialysis through the same catheter and achieved good blood flow without any intradialytic complications.

Conclusions:

In conclusion, this case highlights the importance of vigilant monitoring and prompt investigation of unexpected findings during hemodialysis catheterization. The unexpected placement of the right internal jugular catheter in the left mediastinum led to the discovery of a rare congenital anomaly, Persistent Left Superior Vena Cava (PLSVC) with absent Right SVC.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.