Persistent left superior vena cava is a rare vascular anatomical variant. Although ultrasonography has facilitated the process of central venous catheterization, it cannot be used to locate the tip of a catheter. Postprocedure chest X-ray is desirable for locating the course and tip of the catheter. In our case, initial ultrasonography demonstrated the absence of the right internal jugular vein. This prompted insertion of a central venous catheter on the left side of the neck in the presence of normal vascular anatomy. A subsequent chest X-ray revealed an abnormal course of the catheter consistent with presence of persistent left superior vena cava.