Incidental Finding of an Isolated Persistent Left-Sided Supe
Although a rare finding, persistent left superior vena cava (PLSVC) is the most common anomaly of the thoracic venous system with a prevalence of 0.3 to 0.5% in the general population [3]. It is the result of failure of regression of left anterior, common cardinal veins and left sinus horn during early development. In about 82% of cases, it is accompanied by a normal right sided SVC and the remaining occurs in isolation [4]. Most of the cases are incidental findings during Computed Tomography (CT) scanning of the chest, during Central Venous Catheter (CVC) placement, or during pacemaker lead placement through the left internal jugular or subclavian venous routes. Occasionally, it can be diagnosed on plain films if a catheter is found in the left paramediastinal location. However, majority of the time it is missed on plain films due to the presence of co-existing normal right-sided SVC; though, it can be better visualized by CT scan with contrast. It is usually asymptomatic, except, in cases where a large right to left shunt exists. Here, we report a patient who underwent placement of central venous catheters via the right internal jugular vein and left brachial vein without any complications. The catheters were found to be in its unusual location on the routine post-procedural chest radiograph.

Case Report:
A 48 year old male with no significant past medical history presented with a 6 weeks history of localized back pain, fever, chills, night sweats and thirty pounds of unintentional weight loss. He also complained of progressively worsening neurological symptoms including decreased visual acuity in his right eye, paresthesia involving the 4th and 5th digits of his hands bilaterally which was accompanied by weakness....