A central venous catheter in a persistent left superior vena cava (SVC): Use it or lose it?

Central Venous Catheters (CVC) fill an essential part of treatment with Bacteremia and shock patients in intensive care units. as part of treatment, a 73 years old patient hospitalized due to shock and MSSA bacteremia a CVC needed replacement and a new catheter inserted in the left internal jugular vein. A CXR performed after line insertion shows an unexpected route descending to the left upper mediastinum and suspected to be erroneously placed in the descending aorta. a previous chest computed tomography showed a small persistent left superior vena cava draining in the coronary sinus. In this paper we discuss the dilemma of location and utilization of a CVC in hemodynamically unstable patient.