Published in:
01-05-2019 | Imaging in Intensive Care Medicine
Persistent left superior vena cava: should the central venous catheter be left in place?
Published in: Intensive Care Medicine | Issue 5/2019
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A central catheter was inserted without difficulty through the left internal jugular (LIJ) vein in a 69-year-old male patient. Anteroposterior chest X-ray showed the central catheter entering from the LIJ vein and descending through the left mediastinal border (Fig. 1). A transthoracic echocardiogram (TTE) showed gross dilatation of the coronary sinus (CS) (Fig. 2). A 10-ml agitated saline bolus through the central catheter demonstrated the bubbles filling first the coronary sinus and then the right atrium through it, confirming the diagnosis of persistent left superior vena cava (PLSVC) (Video 1). Chest computed tomography (CT) corroborated this diagnosis (Fig. 3).
Fig. 1
Anteroposterior chest X-ray showing the central catheter entering from the left internal jugular vein and descending through the left mediastinal border (arrows). Also note the dual-chamber pacing leads on the right
Fig. 2
a Grossly dilated coronary sinus observed from a modified apical four-chamber view (arrows). RA right atrium, RV right ventricle, LV left ventricle, da descending aorta. b Grossly dilated coronary sinus observed from a parasternal long axis view as an anechoic cavity (arrows) anterior to the descending aorta (da). LV left ventricle, Aor aortic root, LA left atrium, RVOT right ventricle outflow tract
Fig. 3
a Chest computed tomography with intravenous contrast (a coronal reconstruction; b 3D rendering volume imaging) observing the left superior vena cava (black arrow) emptying in the dilated coronary sinus (arrowheads). The central catheter is inside the left superior vena cava, with its tip found near to the coronary sinus. Pacing leads are seen in the right superior vena cava in (a) (white arrow)
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