The merits of utilizing point of care ultrasound (POCUS) in acutely ill patients is leading to a widespread embrace. Assessment of IVC via POCUS as part of a comprehensive multi-organ approach can help guide volume tolerance. Anatomical/developmental variations of IVC can vary widely in prevalence. As the use of POCUS expands as a diagnostic modality, it is prudent for frontline POCUS users to be cognizant of the IVC anomalies. We present a case of left sided IVC with azygous continuation discovered with POCUS that was performed to assess the volume status of the patient. This case illustrates that the awareness of different anomalies of the IVC is necessary for POCUS users to prevent misinterpretation of aberrant vessels and avoid diagnostic pitfalls.