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.