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PICTURES IN CLINICAL MEDICINE
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Persistent Left Superior Vena Cava (PLSVC) with Anomalous Hepatic Venous Drainage Tetsuya Nomura, Natsuya Keira, Taku Kato and Tetsuya Tatsumi Key words: persistent left superior vena cava, hepatic vein, anomalous drainage (Intern Med 54: 681, 2015) (DOI: 10.2169/internalmedicine.54.3130)
Picture.
A 74-year-old man complaining of dyspnea on effort was diagnosed as having congestive heart failure. An echocardiogram demonstrated ostium secundum atrial septal defect (ASD) and a dilated coronary sinus. In addition, multidetector-row computed tomography (CT) revealed a persistent left superior vena cava (PLSVC), and the left hepatic vein drained directly into the right atrium at the junction of the coronary sinus (Picture). Surgical repair for ASD was performed under cardiopulmonary bypass with four venous cannulas. PLSVC is a rare but important congenital anomaly reported to be present in approximately 0.4% of the population, and complication with anomalous hepatic venous drainage is remarkably uncommon (1, 2). CT angiography is a preferred modality for diagnosing PLSVC and evaluating
the full extent of vascular anomalies. Although PLSVC is not life-threatening, it does affect procedures such as venous catheterization. Therefore, it is important to determine the patient’s precise anatomy using CT angiography in advance. The authors state that they have no Conflict of Interest (COI).
References 1. Azuma C, Tohno Y, Tohno S, Moriwake Y, Utsumi M, Yamada M. Persistent left hepatic venous connection with the right atrium and the ductus venosus. Anat Sci Int 77: 124-127, 2002. 2. Bhatti S, Hakeem A, Ahmad U, Malik M, Kosolcharoen P, Chang SM. Persistent left superior vena cava (plsvc) with anomalous left hepatic vein drainage into the right atrium: Role of imaging and clinical relevance. Vasc Med 12: 319-324, 2007.
Department of Cardiovascular Medicine, Nantan General Hospital, Japan Received for publication April 19, 2014; Accepted for publication August 6, 2014 Correspondence to Dr. Tetsuya Nomura, [email protected] Ⓒ 2015 The Japanese Society of Internal Medicine Journal Website: http://www.naika.or.jp/imonline/index.html
681
PICTURES IN CLINICAL MEDICINE
□
Persistent Left Superior Vena Cava (PLSVC) with Anomalous Hepatic Venous Drainage Tetsuya Nomura, Natsuya Keira, Taku Kato and Tetsuya Tatsumi Key words: persistent left superior vena cava, hepatic vein, anomalous drainage (Intern Med 54: 681, 2015) (DOI: 10.2169/internalmedicine.54.3130)
Picture.
A 74-year-old man complaining of dyspnea on effort was diagnosed as having congestive heart failure. An echocardiogram demonstrated ostium secundum atrial septal defect (ASD) and a dilated coronary sinus. In addition, multidetector-row computed tomography (CT) revealed a persistent left superior vena cava (PLSVC), and the left hepatic vein drained directly into the right atrium at the junction of the coronary sinus (Picture). Surgical repair for ASD was performed under cardiopulmonary bypass with four venous cannulas. PLSVC is a rare but important congenital anomaly reported to be present in approximately 0.4% of the population, and complication with anomalous hepatic venous drainage is remarkably uncommon (1, 2). CT angiography is a preferred modality for diagnosing PLSVC and evaluating
the full extent of vascular anomalies. Although PLSVC is not life-threatening, it does affect procedures such as venous catheterization. Therefore, it is important to determine the patient’s precise anatomy using CT angiography in advance. The authors state that they have no Conflict of Interest (COI).
References 1. Azuma C, Tohno Y, Tohno S, Moriwake Y, Utsumi M, Yamada M. Persistent left hepatic venous connection with the right atrium and the ductus venosus. Anat Sci Int 77: 124-127, 2002. 2. Bhatti S, Hakeem A, Ahmad U, Malik M, Kosolcharoen P, Chang SM. Persistent left superior vena cava (plsvc) with anomalous left hepatic vein drainage into the right atrium: Role of imaging and clinical relevance. Vasc Med 12: 319-324, 2007.
Department of Cardiovascular Medicine, Nantan General Hospital, Japan Received for publication April 19, 2014; Accepted for publication August 6, 2014 Correspondence to Dr. Tetsuya Nomura, [email protected] Ⓒ 2015 The Japanese Society of Internal Medicine Journal Website: http://www.naika.or.jp/imonline/index.html
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