Superior Vena Cava Duplication: The Red Herring of Central Line Placement

Persistent left-sided SVC: An incidental finding during Port-A-Cath placement

Port-A-Cath (port), a single-lumen, tunneled catheter, is routinely placed into the superior vena cava (SVC) for cancer patients undergoing chemotherapy. We present a case of a port placement in which variant anatomy was discovered during the fluoroscopy-guided procedure and confirmed by venogram of a persistent left-sided SVC (PLSVC). Upon further investigation into the patient's previous computed tomography (CT) scans, the diagnosis was further confirmed. Patients with PLSVC are typically asymptomatic; however, some are associated with increased congenital heart defects (CHD), which increase the risk for complications during invasive procedures. Diagnosing PLSVCs and knowing the clinical implications/complications can improve patient care; by not removing catheters unnecessarily and being prepared to treat/minimize complications.

Lung Perfusion Scintigraphy Reveals a Duplicated Superior Vena Cava With a Right-to-Left Shunt: A Rare Vascular Variant

Lung perfusion scintigraphy is a common nuclear medicine exam performed for the evaluation of pulmonary emboli, often in the emergency setting. There can be confusion when a radiotracer is located outside of the normal physiologic distribution. This can occur due to improper radionuclide tagging or may be due to anatomic variations. We present a case where a patient presented with bilateral lower extremity deep vein thrombosis and a nuclear medicine lung perfusion scintigraphy showing a complete right-to-left shunt related to a rare anatomical variant of a duplicated superior vena cava (SVC) with the right SVC draining directly into the systemic circulation via the left atrium.

Cardiac CT and Transesophageal Echocardiogram Evaluation of a Sinus Venosus-Type Atrial Septal Defect With Partial Anomalous Pulmonary Venous Return and a Persistent Left Superior Vena Cava

The sinus venosus (SV) plays a significant role in the embryological heart as the initial structure where the cardinal, umbilical, and vitelline veins drain before remodeling into the caval veins. As the human heart develops, the SV incorporates into the posterior wall of the right atrium. Sinus venosus atrial septal defects (SVASDs) result from a defect in the wall present among the right pulmonary veins, the superior vena cava (SVC), and the right atrium. Persistent left superior vena cava (PLSVC) occurs when the Marshall ligament does not regress, and in most cases, the PLSVC enters the coronary sinus before draining into the right atrium. Pulmonary hypertension from chronic left to right shunting makes recognizing this condition clinically significant. In this case report, both cardiac CT and transesophageal echocardiogram were used to further evaluate an SVASD with partial anomalous pulmonary venous return (PAPVR) of the right superior pulmonary vein, in addition to a PLSVC. The incidence of the co-occurrence of SVASD and PLSVC, as well as the association between the two, were discussed in this case report. Future research should focus on the potential genetic causes of this co-occurrence. It should also focus on patient treatment and outcomes at different stages of presentation to optimize patient management and improve mortality.