Persistent Left Superior Vena Cava: Implications of Surgical | Figure 1
JIMHICR
Persistent Left Superior Vena Cava: Implications of Surgical Management
Persistent left superior vena cava is the most common congenital anomaly of thoracic venous return, which results when the left anterior cardinal vein fails to regress. A 41-year-old African American male with a history of an unspecified childhood cardiac murmur presented to the emergency department with congestive heart failure exacerbation revealing an incidental finding of a persistent left superior vena cava. Ultimately, he required implantable cardioverter defibrillator placement and cardiac transplantation assessment. In the setting of advanced device placement or cardiac transplantation, a persistent left superior vena cava warrants several important clinical considerations at a center capable of addressing the possibility of a right-sided approach and transplantation irregularities.
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Axial contrast-enhanced CT of the abdomen shows a rectangular area of increased early hepatic parenchymal enhancement (arrow) within segment IV of the liver. This finding is termed the hot quadrate sign and is a finding of superior vena cava obstruction. Small venous collateral vessels (arrowhead) are shunting blood between the superior vena cava and the left portal vein via internal mammary and paraumbilical veins. This finding is termed the hot quadrate sign and is a finding of superior vena cava obstruction. Coronal contrast-enhanced CT of the chest (image 2) shows lymphoma (arrow) causing obstruction of the superior vena cava (arrowhead).](https://app.figure1.com/case-detail/69c5abff-de3c-4611-847e-43f52f4066a2)