CASE 3678 Published on 20.06.2005
0

Persistent Left Vena Cava : retrospectively gated multislice spiral CT

Section

Cardiovascular

Case Type

Anatomy and Functional Imaging

Authors

JC Le Van An, C Iffenecker

Connected authors
Patient

82 years, male

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Clinical History
A 82 year-old patient underwent in our institution pacemaker implantation. Routinely the left subclavian vein was used for permanent pacing. During the procedure, the guidewire enters the left subclavian vein but does not cross the spinal column, rather lies parallel to it before entering the coronary sinus.
Imaging Findings
A 82 year-old patient underwent in our institution pacemaker implantation. Routinely the left subclavian vein was used for permanent pacing. During the procedure, the guidewire enters the left subclavian vein but does not cross the spinal column, rather lies parallel to it before entering the coronary sinus. A multislice spiral CT and a retrospectively Gated multislice spiral CT is performed. CT scan demonstrated double superior Vena Cava and absence of left innominate vein. The left superior Vena Cava is connected to right atrium via a dilated coronary sinus.
Discussion
Persistent left vena cava (PLSVC) is the most common thoracic venous anomaly .The prevalence of LSVC (in the general population is about 0.3%, as established by an autopsy study. Its prevalence is much higher in patients with congenital cardiac abnormalities, ranging from 2.8% to 4.3%. PLSVC is the result of a persistent patency of an embryological vessel (left anterior cardinal vein).It usually drain into the right atrium through a dilated coronary sinus .In some case, it may drain directly to the left atrium producing a right-to-left shunt or directly into the right atrium. The recognition of this anomaly is of main importance in venous catheterization or pacemaker implantation. CT scan demonstrated existence of left superior Vena Cava. ECG gated multislice spiral CT is interesting to show where PLSV is draining and to search for associated congenital cardiac abnormalities.
Differential Diagnosis List
Persistent left vena cava
Final Diagnosis
Persistent left vena cava
Case information
URL: https://eurorad.org/case/3678
DOI: 10.1594/EURORAD/CASE.3678
ISSN: 1563-4086
Figure 1

Coronal MPR reconstruction

Coronal MPR reconstruction
usually, the left subclavian drain to left inominate vein, vena cava superior and left atrium
Coronal MPR reconstruction
thoracic venous anomaly : the left subclavian drain to persistent left vena cava superior and into the right atrium through a dilated coronary sinus
Figure 2

axial CT slice (left side: normal patient, right side: thoracic venous anomaly)

axial CT slice (left side: normal patient, right side: thoracic venous anomaly)
at left side normal patient: left inominate vein (green arrow head) and right superior vena cava (red arrow head) is present at right side persistent left superior vena cava: absence of inominate vein (green arrow head) and presence of right superior vena cava (red arrow head) and persistent left superior vena cava (blue arrow head)
axial CT slice (left side: normal patient, right side: thoracic venous anomaly)
at left side normal patient: absence of left vena cava at right side persistent left superior vena cava: persistent left superior vena cava (blue arrow head)
axial CT slice (left side: normal patient, right side: thoracic venous anomaly)
axial CT slice (left side: normal patient, right side: thoracic venous anomaly)
ecg gated ct slice : dilated coronary sinus
Figure 3

3 d reconstruction

3 d reconstruction
persistent left superior vena cava drain into dilated coronary sinus
3 d reconstruction
left superior vena cava drain into dilated coronary sinus
Figure 4

Coronal MPR reconstruction

Coronal MPR reconstruction
persistent left superior vena cava drain into dilated coronary sinus