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Open Access 12-12-2022 | Image Puzzle – Answer

A rare finding on computed tomography angiography performed to exclude pulmonary embolism

Auteurs: Vivan J. M. Baggen, Léon J. P. M. van Woerkens, Robert M. Kauling, Atilla Dirkali

Gepubliceerd in: Netherlands Heart Journal | Uitgave 4/2023

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Answer

The right superior vena cava (SVC) drains into the left atrium (Fig. 1, arrow). This would normally cause hypoxaemia due to right-left shunting, as the venous return from the entire upper body is shunted to the systemic circulation. However, this patient also has a persistent left SVC, which drains via the coronary sinus into the right atrium (Fig. 1, asterisk). Hence, only the venous return of the right upper hemithorax is shunted. On reassessment, echocardiography was found to show a dilated coronary sinus, which is a common finding in persistent left SVC.
Isolated persistent left SVC occurs in ~ 0.3–0.5% of the general population. Persistent left SVC is associated with other cardiovascular abnormalities in 40% of cases [1]. Isolated right SVC drainage into the left atrium is extremely rare. Approximately 20 cases have been reported, mostly in children presenting with mild hypoxaemia and cyanosis. The current combination of right SVC drainage into the left atrium and persistent left SVC has been reported in only three patients [2, 3]. Its incidence is possibly underestimated due to the lack of clinical symptoms.
The patient was referred to a tertiary centre for congenital heart disease. On re-evaluation the patient reported no palpitations and no limitation of ordinary physical activity. Exercise testing including saturation sampling showed an arterial oxygen saturation at rest of 96%, with a gradual decrease during exercise to 93%. Because of the limited clinical symptoms, there was no indication for surgical correction. Future venous injections via the right arm should be avoided, to prevent systemic embolism.

Conflict of interest

V.J.M. Baggen, L.J.P.M. van Woerkens, R.M. Kauling and A. Dirkali declare that they have no competing interests.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://​creativecommons.​org/​licenses/​by/​4.​0/​.
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Netherlands Heart Journal

Het Netherlands Heart Journal wordt uitgegeven in samenwerking met de Nederlandse Vereniging voor Cardiologie. Het tijdschrift is Engelstalig en wordt gratis beschikbaa ...

Literatuur
1.
go back to reference Goyal SK, Punnam SR, Verma G, Ruberg FL. Persistent left superior vena cava: a case report and review of literature. Cardiovasc Ultrasound. 2008;6:50.CrossRefPubMedPubMedCentral Goyal SK, Punnam SR, Verma G, Ruberg FL. Persistent left superior vena cava: a case report and review of literature. Cardiovasc Ultrasound. 2008;6:50.CrossRefPubMedPubMedCentral
2.
go back to reference Schick EC Jr, Lekakis J, Rothendler JA, Ryan TJ. Persistent left superior vena cava and right superior vena cava drainage into the left atrium without arterial hypoxemia. J Am Coll Cardiol. 1985;5:374–8.CrossRefPubMed Schick EC Jr, Lekakis J, Rothendler JA, Ryan TJ. Persistent left superior vena cava and right superior vena cava drainage into the left atrium without arterial hypoxemia. J Am Coll Cardiol. 1985;5:374–8.CrossRefPubMed
3.
go back to reference Leys D, Manouvrier J, Dupard T, et al. Right superior vena cava draining into the left atrium with left superior vena cava draining into the right atrium. Br Med J. 1986;293:855.CrossRef Leys D, Manouvrier J, Dupard T, et al. Right superior vena cava draining into the left atrium with left superior vena cava draining into the right atrium. Br Med J. 1986;293:855.CrossRef
Metagegevens
Titel
A rare finding on computed tomography angiography performed to exclude pulmonary embolism
Auteurs
Vivan J. M. Baggen
Léon J. P. M. van Woerkens
Robert M. Kauling
Atilla Dirkali
Publicatiedatum
12-12-2022
Uitgeverij
Bohn Stafleu van Loghum
Gepubliceerd in
Netherlands Heart Journal / Uitgave 4/2023
Print ISSN: 1568-5888
Elektronisch ISSN: 1876-6250
DOI
https://doi.org/10.1007/s12471-022-01744-1

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