The value of a chest radiograph for diagnosing a misplaced PICC line in the persistent left-sided superior vena cava.

To cite: Joshi D, Ridley N, Imam A. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2014205096 DESCRIPTION Most peripherally inserted central catheters (PICC-lines) in our institution are placed without real-time fluoroscopy. However, every patient has a completion chest radiograph, which is reported by a radiologist to confirm the tip of the PICC-line in the superior vena cava. Any deviation from the desired position is rectified. A 42-year-old woman had a PICC-line insertion in her left arm. The chest radiograph demonstrated that the PICC-line was abnormally placed along the left mediastinal border (figure 1), contrary to its normal course into the superior vena cava along the right border (figure 1). A previous CT scan demonstrated a persistent left-sided superior vena cava (PLSVC; figure 2). It was also noted that the PLSVC drained into the left atrium (video 1). PLSVCs are found in 0.3% of the population and 90% open normally into the right atrium