An isolated persistent left superior vena cava with an absent right superior vena cava in an asymptomatic patient

Ali Rıza Akyüz, Selim Kul, İsmail Gürbak

Department of Cardiology, Akçaabat Haçkalı Baba State Hospital, Trabzon, Turkey

DOI : 10.5606/tgkdc.dergisi.2015.11161

A 42-year-old male patient was admitted to our cardiology clinic because of atypical chest pain. He did not have any relevant medical history, and his physical examinations and laboratory results revealed no abnormalities. However, transthoracic echocardiography showed a large dilated coronary sinus (Figure 1). After injecting saline into the left antecubital vein, the contrast first seeped into the coronary sinus and then the right atrium. Afterwards, when the right antecubital vein was injected with an agitated saline solution, it seeped into the dilated coronary sinus and then emptied into the right atrium. Hence, we suspected there was a persistent left superior vena cava (PLSVC) with an absent right superior vena cava (RSVC). In order to more obviously illustrate this, computed tomography (CT) was performed, which confirmed our suspicions (Figure 2-4).

Figure 1: Echocardiogram showing the dilated coronary sinus (CS).

Figure 2: Computed tomographic image showing the right superior vena cava (narrow arrow on the left) joining with the left superior vena cava (thick arrow) and forming the coronary sinus.

Figure 3: Computed tomographic image showing the dilated left superior vena cava (arrow).

Figure 4: Computed tomographic image showing the absence of the right superior vena cava (curved arrow) and the dilated left superior vena cava (arrow).

The presence of a PLSVC with an absent RSVC is an extremely rare congenital venous anomaly. Furthermore, PLSVCs are generally asymptomatic and are usually discovered incidentally. Moreover, this condition often has been reported during the placement of a pacemaker and a central venous catheter. Fortunately, because of modern imaging modalities, such as contrast echocardiography, CT, and magnetic resonance imaging, this anomaly can now be clearly and easily confirmed.[1-3]

Declaration of conflicting interests
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Funding
The authors received no financial support for the research and/or authorship of this article.

References

1) Korkmaz L, Akyüz AR, Erkuş ME, Topal C. Isolated persistent left superior vena cava with absent right superior vena cava in two cases. Turk Kardiyol Dern Ars 2011;39:501-4.

2) Uçar O, Paşaoğlu L, Ciçekçioğlu H, Vural M, Kocaoğlu I, Aydoğdu S. Persistent left superior vena cava with absent right superior vena cava: a case report and review of the literature. Cardiovasc J Afr 2010;21:164-6.

3) Ceylan Ö, Özgür S, Örün UA, Doğan V, Koç M, Yılmaz O, et al. Absent right superior vena cava with persistent left superior vena cava and normal atrial arrangement. Turk Gogus Kalp Dama 2014;22:7-12.

References

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