Persistent left superior vena cava with partial anomalous venous return in a liver transplant patient

Insertion of central venous catheters is commonly performed on critically ill patients. Successful placement requires knowledge of vascular anatomy, but vascular anomalies may pose difficulties during insertion and confirmation of catheter position. This report describes the incidental discovery of a persistent left superior vena cava emptying into a pulmonary vein with partial anomalous pulmonary venous return to the left innominate vein and ultimately into the right superior vena cava, after placement of a left internal jugular central line in a patient presenting for liver transplant. We discuss the clinical implications of persistent left superior vena cava and the steps we took to evaluate catheter position.