• Nami Taniguchi, Tetsuya Kai, Tadashi Kandabashi, Ryohei Miyazaki, and Sumio Hoka.
• Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, Fukuoka 812-8582.
• Masui. 2013 Jul 1;62(7):870-2.

AbstractA 77-year-old man was scheduled to undergo the resection of hepatoma. After the induction of general anesthesia, a central venous (CV) catheter was inserted from the right internal jugular vein under the echographic observation. Then, we noticed that the size of the vein was smaller than usual, which caused a little difficulty in the insertion. The post-insertion chest X-ray showed unusual placement of the catheter's tip toward the left side of the trachea. Re-evaluation of preoperative CT revealed the persistent left superior vena cava (PLSVC) with absent right superior vena cava. Post-operative examination with echography of the neck showed that the left internal jugular vein was much greater than the right. When noticing a small right internal jugular vein in pre-procedure echography, existence of PLSVC should be considered, and meticulous CV catheterization is necessary for safety.

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