Persistent Left Superior Vena Cava and Agitated Saline: A Strategically Thinking Sonographer’s Perspective

Abstract

Comprehension of cardiac anatomy is critical for health care providers and allied health professionals in the pursuit of an accurate and timely patient diagnosis. Many times, when these anomalies are discovered, they are incidental findings from an asymptomatic patient during cardiovascular imaging. One specific anomaly which requires keen attention to detail and critical decision-making abilities is a persistent left superior vena cava (PLSVC). On a transthoracic echocardiogram (TTE), PLSVCs are discovered with the addition of agitated saline, commonly known as bubble studies. Because these anomalies are left-sided, it is critical for the sonographer and IV (intravenous)-trained staff to administer agitated saline through an IV on the left arm. Although rare, PLSVC may correlate with other cardiac pathologies, thus indicating the magnitude of a sonographer’s attention to surrounding anatomy (such as a dilated coronary sinus) and the necessity of appropriate IV location. This case study demonstrated the significance of a strategically thinking sonographer while diagnosing a PLSVC on TTE with agitated saline, which could have been missed if the IV line were not initiated on the left arm.