Successful management of septic patient with concealed left persistent superior vena cava: anaesthetic perspective

Surviving sepsis guideline supports the placement of central venous cannulation (CVC) to target the deranged physiology. The placement of CVC is still challenging, which requires detailed knowledge of venous anatomy and orientation of congenital venous anomalies. Double or persistent left superior vena cava (PLSVC) is a common anomaly in thoracic venous system. Our patient had hidden PLSVC, though he was previously asymptomatic with no cardiac disease. We report the successful anaesthetic management of an adult male with septicaemia for emergency laparotomy. CVC was placed in left internal jugular vein under vision by ultrasonography for fluid and vasopressor requirement. The incidental PLSVC was initially diagnosed on routine post procedure chest X-ray. Later it was confirmed by transthoracic echocardiography with an agitated saline micro bubbles contrast media.We conclude that the routine post CVC chest X ray is mandatory not only to identify the correct positioning of CVC placement but also very helpful in identifying the underlying rare anomalies.