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Esophago-pleural fistula is a rare entity. A young patient presented with chest discomfort after taking food and occasional cough. Computed tomography scan of thorax revealed esophago-pleural fistula. Intraoperatively, there was a BPF in the right lower lobe. The fistulous diverticulum was excised followed by primary repair of the esophagus and reinforced with intercostal muscle flap with buttressing of BPF by soft tissue flap. Patient was discharged uneventfully under coverage of ATT. Primary repair and reinforcement by myoplasty have superadded advantage over endoscopic procedures where recurrence rate is high. So, proper evaluation and timely management are required to prevent morbidity and mortality.

The venous anomaly of a persistent left superior vena cava (PLSVC) affects 0.3%–0.5% of the general population. PLSVC with absent right superior vena cava, also termed as “isolated PLSVC,” is an extremely rare venous anomaly. Almost half of the patients with isolated PLSVC have cardiac anomalies in the form of atrial septal defect, endocardial cushion defects, or tetralogy of Fallot. Isolated PLSVC is usually innocuous. Its discovery, however, has important clinical implications. It can pose clinical difficulties with central venous access, cardiothoracic surgeries, and pacemaker implantation. When it drains to the left atrium, it may create a right to left shunt. In this case report, we present the incidental finding of isolated PLSVC in a patient who underwent aortic valve replacement. Awareness about this condition and its variations is important to avoid complications.