Bronchobiliary fistula (BBF) is a rare condition that results from the communication between the bile ducts and the bronchial tree. It is characterized by the presence of bile in the sputum as pathognomonic symptom, and it is often associated with suspicious pneumonia. The most common causes include infections (e.g. echinococcosis), hepatobiliary surgery, blunt torso traumas, tumors and percutaneous transhepatic procedures. Opinions about BBF treatment are still controversial as it can be treated by both conservative and surgical procedures, while pharmacological treatments are only rarely used. This case report presents a patient who had been diagnosed with chronic BBF of unknown cause, underwent several ineffective conservative procedures and was at last surgically treated.

METHODS: Female, 50 FINAL DIAGNOSIS: Double superior vena cava Symptoms: -
METHODS: - Clinical Procedure: - Specialty: Nephrology.
OBJECTIVE: Anatomical anomaly/variation.
BACKGROUND: Superior vena cava anomalies are caused by variations in the development of the embryonic thoracic venous system. Duplication of the superior vena cava is a rare anomaly with an incidence in the general population of 0.3%. The majority of cases are asymptomatic and diagnosed incidentally by imaging done for another reason.
METHODS: A fifty year old female patient presented to our care with a history of end stage renal disease that has been recently started on dialysis. Procedures performed included a fistulogram, PermaCath placement and angiogram of internal jugular vein. Angiogram was done and showed that the patient has a good sized cephalic vein which is wide open and mild to moderate stenosis at the subclavian area which proved to be a dual superior vena cava.
CONCLUSIONS: Double SVC is a rare congenital anomaly. The literature available on this congenital anomaly is sparse. The majority of cases are diagnosed incidentally on imaging for other reasons, which can alert the physician of other congenital abnormalities that will need further work up. However, these venous anomalies should be recognized, as they can have significant clinical implications, especially during central venous catheter placement, radiofrequency ablation, pacemaker insertion or coronary artery bypass graft.