Unusual placement of a dialysis catheter: persistent left superior vena cava

Area of Science:

• Nephrology
• Radiology
• Anatomy

Background:

• Noncuffed dialysis catheters are crucial for immediate hemodialysis access.
• The right internal jugular vein is the preferred site for catheter placement.
• Left internal jugular vein access is an alternative when right-sided access is unavailable or has failed.

Observation:

• Placement of hemodialysis catheters in the left internal jugular vein can be necessary.
• A persistent left superior vena cava is an anatomical variant that may be encountered.
• Routine chest radiographs confirm catheter placement.

Findings:

• A persistent left superior vena cava can mimic catheter malposition on chest radiographs.
• This anatomical variant may lead to misinterpretation of routine imaging.
• Failure to recognize this variant can result in inappropriate clinical responses.

Implications:

• Nephrologists must be aware of the persistent left superior vena cava for accurate interpretation of chest radiographs.
• Recognition prevents unnecessary interventions and ensures appropriate patient management.
• Understanding this variant improves the safety and efficacy of hemodialysis catheter placement.