Presentation
Routine PICC line placement for long term antibiotics.
Patient Data
Injection from the right subclavian vein shows contrast passing down a right mediastinal vein. The later runs show filling of the right atrium, proving that this is a right SVC which has an anomalous origin, rather than the azygos vein. A left SVC is also seen.
Injection of the left SVC shows a ventricle. The last frames show filling of the pulmonary artery, proving that this is the right ventricle, not the left. The PICC line can safely be left in this position.
Case Discussion
Left SVCs are not a rare anomaly (0.5%). It is usually part of a duplication (bilateral SVC), as in this case. The left SVC will rarely drain into the left atrium, and therefore it would be hazardous to leave a PICC line in this position (systemic embolism risk). The demonstration of the pulmonary artery in the second angiogram has important implications for the final position of the PICC.
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