Echocardiography-Guided Repositioning of a Hemodialysis Catheter in a Patient With Persistent Left Superior Vena Cava: A Case Report

Figure 1. Chest computed tomography showing bilateral pleural effusions and subcutaneous edema

Figure 2. Abdominal computed tomography demonstrating large-volume ascites

Figure 3. Hematoxylin and eosin-stained bone marrow showing increased megakaryocytes with background marrow fibrosis.

Figure 4. Reticulin-stained bone marrow Increased reticulin fibers are present (MF-1 to MF-2), consistent with reticulin fibrosis described in TAFRO syndrome in the appropriate clinical context. TAFRO: Thrombocytopenia, Anasarca, Fever, Reticulin fibrosis/Renal dysfunction, and Organomegaly

Figure 5. Chest radiograph after hemodialysis catheter insertion, showing the catheter descending along the left border of the mediastinum (arrow).

Figure 6. The hemodialysis catheter (arrow) is visualized as a hyperechoic structure within the PLSVC. LV: left ventricle; PLSVC: persistent left superior vena cava

Figure 7. The coronary sinus (arrow) is visualized immediately caudal to the catheter tip. LV: left ventricle

Figure 8. Transthoracic echocardiography performed in the clinical laboratory after admission shows the persistent left superior vena cava (arrow) in an apical four-chamber view. The heart serves as an acoustic window, allowing the anomalous vein to be visualized adjacent to the left atrium.

Figure 9. Contrast-enhanced chest CT shows the persistent left superior vena cava (arrow) running along the left side of the mediastinum in close relationship to the heart. This anatomical configuration explains why the vessel can be depicted in the apical four-chamber echocardiographic view.