Multiple thromboembolic events associated with bilateral superior vena cava and anomalous drainage into the left atrium

Abstract

A 49-year-old female patient presented with acute-on-chronic chest pain. She was diagnosed with multiple systemic thromboemboli, including myocardial infarctions, bilateral chronic pulmonary emboli, ischaemic stroke, deep venous thrombosis and superficial thrombophlebitis. She had a background of sickle cell trait. Cardiac magnetic resonance showed bilateral superior vena cava (SVC). The right-sided SVC (RSVC) was joined by the right upper pulmonary vein and drained anomalously into the left atrium. This caused a small volume right to left shunt. The persistent left SVC drained into the right atrium (RA) via a dilated coronary sinus. The overall clinical impression was recurrent paradoxical emboli due to anomalous venous anatomy with a thrombophilia secondary to sickle cell trait. In the normal embryo, the right common cardinal vein develops to become the RSVC, which drains into the RA by term.

Intramedullary spinal cord abscess associated with right-to-left shunt via right superior vena cava draining into left atrium: A case report

“…Three cases were female, and the median age was 46.5 (range, 34–65) years. Past history of myocardial infarction was reported in two cases, [ 6 , 17 ] and our patient similarly developed a transient acute cardiac syndrome caused by an air embolus, which led to identification of his RSVC-LA RL shunt. Past history of brain abscess was reported in one case.…”

“…To the best of our knowledge, only 6 detailed case reports of neurological complications secondary to an RSVC-LA RL shunt have been published (Table 2 ) in the English-language literature: three cases of brain abscess [ 6 , 12 , 13 ] and three cases of cerebrovascular disorder. [ 7 , 15 , 17 ] Our article is the first case description of ISCA in a patient with an RSVC-LA RL shunt. Three cases were female, and the median age was 46.5 (range, 34–65) years.…”

“…[ 15 ] Remarkably, hypoxemia due to RL shunt was seen in three cases despite their normal growth and development. [ 7 , 12 , 13 ] Unsurprisingly, symptoms, treatments, and outcomes vary among the cases [ 6 , 7 , 12 , 13 , 15 , 17 ] according to their neurological complications and affected regions. To prevent further complications due to RL shunt, surgical intervention was performed in three cases, [ 7 , 12 , 13 ] and oral antithrombotic therapy was undergone in one case.…”

“…To prevent further complications due to RL shunt, surgical intervention was performed in three cases, [ 7 , 12 , 13 ] and oral antithrombotic therapy was undergone in one case. [ 17 ] While our patient continues to take oral antibiotics to prevent recurrence of the abscess or systemic infection, surgical intervention was deemed unnecessary due to the absence of hypoxemia or heart failure. We also instructed him that an intravenous catheter must not be placed in his right arm to avoid a risk of accidental complications caused by air embolus.…”

“…This case identifies RL shunt as an important etiological agent of ISCA, and hence, screening for RSVC-LA RL shunt may be beneficial to patients with cryptogenic ISCA as its identification can lead to appropriate preventive therapy. Author Schick et al 1985 [6] Leys et al 1986 [12] Sadek et al 2006 [7] Hong et al 2011 [13] Clark and MacDonald 2015 [15] Karavassilis et al 2021 [17]…”