Persistent left superior vena cava: clinical importance and differential diagnoses

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Abstract

Persistent left superior vena cava (PLSVC) is the most common thoracic venous anomaly and may be a component of the complex cardiac pathologies. While it is often asymptomatic, it can lead to significant problems such as arrhythmias and cyanosis. Besides, it can cause serious complications during vascular interventional procedures or the surgical treatment of cardiac anomalies (CA). The clinical significance of PLSVC depends on the drainage site and the accompanying CA. In this article, we will describe the epidemiology, embryology, and anatomic variations of PLSVC. Possible accompanying CA and heterotaxy spectrum will be reviewed with the help of multidetector computed tomography (MDCT) images. Radiological pitfalls, differential diagnoses, and the clinical importance of PLSVC will be highlighted.

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Most cited references 29

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Persistent left superior vena cava: a case report and review of literature

Sandeep Goyal, Sujeeth R Punnam, Gita Verma … (2008)

Persistent left superior vena cava is rare but important congenital vascular anomaly. It results when the left superior cardinal vein caudal to the innominate vein fails to regress. It is most commonly observed in isolation but can be associated with other cardiovascular abnormalities including atrial septal defect, bicuspid aortic valve, coarctation of aorta, coronary sinus ostial atresia, and cor triatriatum. The presence of PLSVC can render access to the right side of heart challenging via the left subclavian approach, which is a common site of access utilized when placing pacemakers and Swan-Ganz catheters. Incidental notation of a dilated coronary sinus on echocardiography should raise the suspicion of PLSVC. The diagnosis should be confirmed by saline contrast echocardiography.

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Collateral pathways in portal hypertension.

Malay Sharma, Chittapuram S Rameshbabu (2012)

Presence of portosystemic collateral veins (PSCV) is common in portal hypertension due to cirrhosis. Physiologically, normal portosystemic anastomoses exist which exhibit hepatofugal flow. With the development of portal hypertension, transmission of backpressure leads to increased flow in these patent normal portosystemic anastomoses. In extrahepatic portal vein obstruction collateral circulation develops in a hepatopetal direction and portoportal pathways are frequently found. The objective of this review is to illustrate the various PSCV and portoportal collateral vein pathways pertinent to portal hypertension in liver cirrhosis and EHPVO.

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Left superior vena cava: revisited.

M. Schmitt, M. Greaves, R B Irwin (2012)

The persistence of a left-sided superior vena cava is the most common variant of systemic venous drainage. Increased utility of cardiac imaging, in particular cross-sectional techniques such as computed tomography and magnetic resonance (MR), will result in increased detection of the anomaly and its variants. Whilst in the typical form it is often haemodynamically insignificant, its discovery may have clinical significance nonetheless, and its mimics require exclusion. During cardiac development the anomaly results from a failure of the left anterior cardinal vein to obliterate. Recognized anatomical variants include the absence of the right superior vena cava and of an innominate bridging vein. Typical drainage is to the coronary sinus, dilatation of which may be the first hint to the anomaly. Clinical implications with respect to vascular access and arrhythmia are well described. A significant minority drain into the left atrium, potentially creating a haemodynamically significant lesion. Additionally, differentiation from anomalous left upper pulmonary venous drainage via a vertical vein is mandatory. A newly discovered variant runs an intra-atrial course with subsequent typical drainage, and if not recognized as such, may be confused with a left atrial mass. The use of 3D contrast-enhanced MR venography has proven extremely helpful in characterizing anomalous vasculature, and we demonstrate how such techniques can help delineate the anomaly and differentiate from its mimics.

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Author and article information

Contributors

Tuncay Hazirolan: tuncayhazirolan@gmail.com

Journal

Journal ID (nlm-ta): Insights Imaging

Journal ID (iso-abbrev): Insights Imaging

Title: Insights into Imaging

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Electronic): 1869-4101

Publication date (Electronic): 15 October 2020

Publication date PMC-release: 15 October 2020

Publication date Collection: December 2020

Volume: 11

Electronic Location Identifier: 110

Affiliations

GRID grid.14442.37, ISNI 0000 0001 2342 7339, Department of Radiology, , Hacettepe University School of Medicine, ; 06100 Ankara, Turkey

Article

Publisher ID: 906

DOI: 10.1186/s13244-020-00906-2

PMC ID: 7561662

PubMed ID: 33057803

SO-VID: 5c066913-6e01-42ca-ba19-20727debc8fd

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Open AccessThis 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/.

History

Date received : 15 May 2020

Date accepted : 20 August 2020

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ScienceOpen disciplines: Radiology & Imaging

Keywords: persistent left superior vena cava,cardiac anomalies,clinical significance,differential diagnoses,computerized tomography

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ScienceOpen disciplines: Radiology & Imaging

Keywords: persistent left superior vena cava, cardiac anomalies, clinical significance, differential diagnoses, computerized tomography

Persistent left superior vena cava: clinical importance and differential diagnoses

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Probing cerebral hemodynamics with BOLD fMRI

Most cited references 29

Persistent left superior vena cava: a case report and review of literature

Collateral pathways in portal hypertension.

Left superior vena cava: revisited.

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