Pseudo-faulty location of a Swan-Ganz catheter in a persistent left superior vena cava

The insertion of a Swan-Ganz catheter may cause various complications including intravascular malpositioning due to congenital anomalies of the large veins. A persistent left superior vena cava is the most frequent anomaly of the large vessels. It is usually diagnosed either as an incidental finding at autopsy or during X-ray imaging for confirming proper position of central venous and pulmonary catheters. The incidence of this condition based on autopsy series is approximately 0.3%. CASE REPORT. A 52-year-old patient was admitted to the surgical ICU with the diagnosis of acute pancreatitis. Because of haemodynamic instability, a pulmonary artery flotation catheter was inserted via the left subclavian vein without difficult. The chest radiograph showed the catheter along the left border of the heart going into the right pulmonary artery. An angiographic examination with bolus contrast injection confirmed a persistent left superior vena cava. CONCLUSION. This type of malposition calls for further detailed diagnosis of the vascular status, as the knowledge of accompanying congenital cardiovascular defects is essential for further invasive diagnostic and surgical procedures. The intensivist should be aware of its occurrence in order to not mistake catheters as being present in the arterial circulation or malpositioned outside the venous circulation.