PERSISTENT LEFT SUPERIOR VENA-CAVA - A CA USE OF MALPOSITIONING OF A SWAN-GANZ CATHETER

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 freq uent anomaly of the large vessels. It is usually diagnosed either as a n incidental finding at autopsy or during X-ray imaging for confirming proper position of central venous and pulmonary catheters. The incide nce of this condition based on autopsy series is approximately 0.3%. C ase report. A 52-year-old patient was admitted to the surgical ICU wit h the diagnosis of acute pancreatitis. Because of haemodynamic instabi lity, a pulmonary artery flotation catheter was inserted via the left subclavian vein without difficult. The chest radiograph showed the cat heter along the left border of the heart going into the right pulmonar y artery. An angiographic examination with bolus contrast injection co nfirmed a persistent left superior vena cava. Conclusion. This type of malposition calls for further detailed diagnosis of the vascular stat us, 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 mis take catheters as being present in the arterial circulation or malposi tioned outside the venous circulation.