Persistent Left Superior Vena Cava – Accidental Finding

Abstract

Background/Aim: The presence of the superior left vena cava represents a rare anomaly of the thoracic venous system. Case Report: An asymptomatic case of this type of anomaly, discovered as an accident during investigations for a different pathology (superior left pulmonary lobe tumor), is presented. A 56-year-old, heavy smoker was admitted in our clinic with a tumoral mass in the left superior pulmonary lobe discovered during a routine chest x-ray. Physical and clinical examination was normal. However, transthoracic echography noted a coronary sinus enlargement, which led to the suspicion of a thoracic venous anomaly. Contrast chest computed tomography pointed out a venous anomaly at the level of the left hemithorax originating from the cervical region, crossing the aortic arch and draining in the coronary sinus. During the examination, contrast substance was not detected in the right superior vena cava, either early or late during the computed tomography. During surgery the presence of a persistent left superior vena cava was observed, coming from the cervical region, crossing lateral to the aortic arch and draining in the coronary sinus. Conclusion: The presence of an enlarged coronary sinus should warn the surgeon about the possibility of a thoracic venous anomaly. Identifying a persistent left superior vena cava is important due to its clinical implications, especially during certain procedures such as mounting central venous lines, cardiac cannulation or implantation of cardiac stimulators. 935

Case report of double superior vena cava and double odd vein with hypoplastic left brachiocephalic vein

“…Complications may include left subclavian vein thrombosis, arrhythmia, coronary sinus perforation, pericardial tamponade, cardiogenic shock, or even death. 11,[18][19][20][21][22] Therefore, amongst this group of patients, more detailed treatment plans are required.…”

Isolated Persistent Left Superior Vena Cava Revealed by an Associated Asthma

“…Most of PLSVC are asymptomatic and have no hemodynamic abnormalities [ 4 ]. It can be detected accidentally during imaging for unrelated symptoms or in the context of a process of intravascular invasive procedure [ 4 ]. However, in some cases, there is abnormal sinus rhythm or bradycardia present in 36% of cases [ 5 ].…”

“…The detection of PLSVC is important when the left subclavian vein is used for catheterization procedures like Swan-Ganz catheterization and usage in renal dialysis [ 2 , 4 ], in chemotherapy, or in cardiac stimulator placement [ 7 , 8 ]. These investigations can be complicated by left subclavian vein thrombosis, cardiac arrhythmia, perforation of the coronary sinus, cardiac tamponade, cardiogenic shock, or even death [ 4 ].…”

“…When using a central venous catheter, drugs can directly enter in the systemic circulation when they are applied from the left brachiocephalic vein [ 4 ]. PLSVC can also be complicated by paradoxical embolism secondary to right-to-left shunt due to draining PLSVC into the right atrium either directly or via an unroofed coronary sinus [ 4 ]. A PLSVC can also cause problems in pacemaker implantation or cardiopulmonary bypass [ 8 ].…”

Double-Sided Superior Vena Cava: Developmental Considerations Associated with the Thymic Veins

“…These reports have indicated an incidence of the PLSVC of about 0.3 to 0.5 %, with an increase to about 3 % in patients with congenital heart disease (Perles et al, 2013). In recent years, advances in imaging techniques have resulted in more case reports of the PLSVC in patients from a variety of clinical departments, including cardiology, radiology and anaesthesiology (Park et al, 2017;Savu et al, 2020;Chen et al, 2021). These discoveries draw attention to the necessity of providing more detailed anatomical information about the PLSVC.…”