A persistent left superior vena cava (PLSVC) is a rare, under-recognized congenital anomaly. The PLSVC is incidentally discovered during central venous access procedures when access is obtained from the left internal jugular vein. The vast majority of PLSVCs drain into the right atrium; however, it is critical to recognize a PLSVC that drains into the left atrium as it can predispose to systemic dispersion of emboli through bypassing the lungs. Additionally, PLSVC catheterization has also been previously reported to be associated with cardiac dysrhythmias, venous stenosis, coronary sinus thrombosis, cardiac tamponade, and cardiac arrest. This case review presents three cases which illustrate the viability and safety of a PLSVC for long-term central venous access in the setting of chemotherapy and hemodialysis. Ascertaining the drainage pattern of a PLSVC with venogram, echocardiography, computed tomography is paramount prior to long-term catheterization.

Percutaneous nephrostomy placement is a common treatment for obstructive uropathy of various causes. Although rare in the literature, tumor seeding along the nephrostomy tract is a potential risk of percutaneous nephrostomy in the treatment of obstructive symptoms secondary to urothelial carcinoma. In this case report, we present one such unusual outcome where urinary bladder urothelial cancer cells metastasized to the paravertebral soft tissues through apparent seeding along a nephroureterostomy tract.