8 Persistent Left Superior Vena Cava

Clinical Presentation

Asymptomatic 30-year-old man

Radiologic Findings

Coned-down PA chest radiograph (Fig. 8.1) demonstrates a subtle vertically oriented left paramediastinal interface lateral to the aortic arch (arrow). Contrast-enhanced chest CT (mediastinal window) (Figs. 8.2, 8.3, 8.4) demonstrates a persistent left superior vena cava (arrow) coursing vertically along the left superior mediastinum lateral to the aortic arch (Fig. 8.2). The vessel courses medial to the left superior pulmonary vein (arrowhead) (Fig. 8.3) and drains into a dilated coronary sinus (S) (Fig. 8.4). Note the coexistent small-caliber right superior vena cava (Figs. 8.2, 8.3)

Diagnosis

Persistent Left Superior Vena Cava

Differential Diagnosis

Left Upper Lobe Partial Anomalous Pulmonary Venous Return (PAPVR)

Fig. 8.1

Fig. 8.2 (Images courtesy of Maysiang Lesar, MD, National Naval Medical Center, Bethesda, Maryland.)

Fig. 8.3

Fig. 8.4

Discussion

Background

A persistent left superior vena cava (PLSVC) is a relatively common anomaly and represents the most frequent form of anomalous venous return to the heart. It occurs in approximately 0.3–0.5% of the general population, with an increased prevalence (4.4%) in patients with congenital heart disease.