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Open Access 29.11.2022 | Images

Left-sided superior vena cava

verfasst von: PhD Elke Schwier, MD Arnold Schneider, MD, PhD Dietrich Henzler, MD Thomas Köhler

Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie

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A 61-yr-old woman with known Turner syndrome (XO syndrome) and obesity, who was not previously diagnosed with cardiac disease except for an asymptomatic right bundle branch block, was postoperatively admitted to the intensive care unit after a planned hemicolectomy for ascending colon carcinoma. She subsequently developed septic shock with acute renal failure and was indicated for renal replacement therapy. The authorized legal representative gave written consent for publication of the images.
A central venous catheter was placed uneventfully via the right-sided internal jugular vein under ultrasound guidance. The correct position was confirmed with endovascular electrocardiography. Then, a 12F, 25-cm double-lumen Shaldon dialysis catheter (Arrow, Teleflex Medical GmbH, Fellbach, Germany) was inserted via the left-sided internal jugular vein without any problems and advanced maximally and fixated. Both lumens could be easily aspirated. The position of the Shaldon catheter was then checked by chest x-ray, which projected left to the cardiac contour. The catheter was initially suspected to be malpositioned but turned out to be situated in a vascular variant. Subsequent computed tomography and echocardiography confirmed that the right-sided superior vena cava emptied into the right atrium, whereas the left-sided superior vena cava showed typical drainage into the markedly dilated coronary sinus. This dilation was responsible for the left-sided widening of the cardiac contour (Figure). Both vessels were completely separate. Although an accessory left-sided superior vena cava is the most common malformation of the venous system, it occurs only rarely with an incidence of 0.3–0.5% in otherwise cardiac-healthy individuals.1,2
Because of the difficult vascular status in the patient, we decided to leave the Shaldon catheter in situ and used it subsequently for continuous renal replacement therapy (CRRT) without any catheter-related complications. Twenty one days after starting CRRT, the patient developed a new septic episode. Unfortunately, she died with multiorgan failure despite maximal therapeutic efforts. The postmortem examination confirmed that cause of death was global heart failure due to acute bilateral pulmonary artery embolism.

Disclosures

The authors do not have any commercial or noncommercial affiliations that may be considered conflicts of interest.

Funding statement

Open Access funding enabled and organized by Projekt DEAL. This project does not have any sources of funding.

Editorial responsibility

This submission was handled by Dr. Stephan K. W. Schwarz, Editor-in-Chief, Canadian Journal of Anesthesia/Journal canadien d’anesthésie.
Open AccessThis article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://​creativecommons.​org/​licenses/​by-nc/​4.​0/​.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Metadaten
Titel
Left-sided superior vena cava
verfasst von
PhD Elke Schwier
MD Arnold Schneider
MD, PhD Dietrich Henzler
MD Thomas Köhler
Publikationsdatum
29.11.2022
Verlag
Springer International Publishing
Erschienen in
Canadian Journal of Anesthesia/Journal canadien d'anesthésie
Print ISSN: 0832-610X
Elektronische ISSN: 1496-8975
DOI
https://doi.org/10.1007/s12630-022-02356-4

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