Transesophageal echocardiography and vascular ultrasound in the diagnosis of catheter-related persistent left superior vena cava thrombosis

Abstract

We refer to a very rare case of catheter-related thrombosis in a trauma patient with persistent left and absent right superior vena cava. The role of ultrasound examination in the early diagnosis and treatment of thrombosis in the setting of intensive care unit (ICU) is thoroughly discussed. A 30-year-old man was admitted to the ICU due to multiple trauma. Six days after right internal jugular vein (IJV) catheter insertion, and during a vascular ultrasound examination, an IJV catheter-related thrombosis was diagnosed. Hence, the catheter was removed, and a follow-up ultrasound examination revealed thrombus remnant in the IJV extended into brachiocephalic vein. Subsequently, to exclude a possible extension of the thrombus in the superior vena cava, a transesophageal echocardiography (TEE) examination was performed. The latter revealed a distended coronary sinus and the presence of persistent left superior vena cava (PLSVC). Additionally, TEE examination disclosed thrombus remnant within the PLSVC that was also confirmed with CT venography. Anticoagulant therapy was started thus preventing major complications such as coronary sinus obstruction. This case underlines the role of cardiovascular ultrasound examination as an important tool in performing variety of monitoring in the setting of the ICU.

Persistent left superior vena cava accompanying congenital heart disease in children: Experience of a tertiary care center

“…Although the prevalence of persistent left SVC in the general population is approximately 0.3%, different studies show that the prevalence rate can range from 4% to 10% in patients with CHD . Similarly, in our study, 3.3% of patients with CHD have persistent left SVC.…”

Transthoracic echocardiography for the diagnosis of left ventricular thrombosis in the postoperative care unit

“…Cardiovascular thrombosis is common in the ICU setting because critically ill patients are immobile and sedated, exposed to thrombin-generating procedures (for example, central venous catheterization) and frequently have other thrombotic risk factors (for example, malignancies or trauma) [12,13]. …”

Persistent left superior vena cava: A possible contraindication to chemotherapy and total parenteral nutrition in cancer patients

“…A CT scan or MRI may be employed to establish the diagnosis. Echocardiography is useful to verify the presence of a dilated coronary sinus and to rule out variations in the typical anomalous venous course (2,8,10,11). In our group of patients, the prevalence of PLSVC was more elevated than in the general population, possibly owing to the choice of inserting the catheter on the left side.…”

“…In 80-90% of individuals, PLSVC drains into the right atrium directly or via the coronary sinus and is of no hemodynamic consequence. In the remaining cases, it may drain into the left atrium, resulting in a right to left sided shunt (1)(2)(3)(4). Almost 40% of patients with PLSVC have a variety of associated cardiac anomalies, such as atrial septal defects, bicuspid aortic valve, coarctation of the aorta, coronary sinus ostial atresia and cor triatrium (9,10).…”

“…PLSVC is present in 0.3-0.5% of the general population (2,3). It is usually asymptomatic and hemodynamically irrelevant or associated with disturbances of cardiac rhythm.…”