Radiological Category Thoracic Chest Principal Modality 1 CT

Case History 69 year old female with history of melanoma for routine surveillance chest

Test Your Diagnosis Which does the visualized abnormality involve? After your selection, go to

Test Your Diagnosis Which one of the following is your choice for the appropriate

Findings and Differentials Findings: Beginning with the most superior images a vessel is noted

Discussion Persistent Left Superior Vena Cava Persistence of the left superior vena cava is

Discussion Also, the vessel receives the left superior intercostal vein and is joined by

Diagnosis Persistent Left Superior Vena Cava References: Learning. Radiology. com: “Persistent Left Superior Vena

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Radiological Category: Thoracic Chest Principal Modality (1): CT Principal Modality (2): None Case Report #0365 Submitted by: Justin Ord, M. D. Faculty reviewer: Emma Ferguson, M. D. Date accepted: 05 February 2007

Case History 69 year old female with history of melanoma for routine surveillance chest ct.

Radiological Presentations

Test Your Diagnosis Which does the visualized abnormality involve? After your selection, go to next page. • Lung Parenchyma • Heart • Vessels • Chest Wall • Thymus

Test Your Diagnosis Which one of the following is your choice for the appropriate diagnosis? After your selection, go to next page. • Double Aortic Arch • Persitant Left SVC • Aberrant Right Subclavian • Aortic Coarctation • Absence of the Left Common Carotid Artery

Findings and Differentials Findings: Beginning with the most superior images a vessel is noted running lateral to the aortic arch, posterior to the left atrium, and connecting to the coronary sinus.

Discussion Persistent Left Superior Vena Cava Persistence of the left superior vena cava is an uncommon vascular anomaly which results from failure of regression of the left anterior and common cardinal veins. However, it is the most common thoracic venous anomaly, and affects approximately 0. 3% of the general population, and 4 -11% of patients with congenital heart disease. In 90% of the cases, the left superior vena cava connects with the right atrium via the coronary sinus. In 10% of cases, it connects with the right atrium. The key to diagnosis is the course of the aberrant vessel. As aforementioned, in 90% of cases, it begins at the junction of the left subclavian and internal jugular veins, passes lateral to the aortic arch anterior to the left hilum, crosses posterior to the posterior wall of the left atrium, and receives the great cardiac vein to become the coronary sinus.

Discussion Also, the vessel receives the left superior intercostal vein and is joined by the hemiazygous system. In 10%, the vessel course is the same rostrally, but as it approaches the heart, it courses between the left atrial appendage and the left superior pulmonary vein to enter the left atrium. Often the left brachiocephalic vein is small or absent. Most commonly, a right and left SVC will be visualized. However, in 10 -18% of cases, the right SVC will be absent. A persistant left SVC by itself is considered benign, but is frequently associated with more significant cardiac abnormalities, such as VSD and ASD.

Diagnosis Persistent Left Superior Vena Cava References: Learning. Radiology. com: “Persistent Left Superior Vena Cava. ” Wikipedia. org: “Persistent Left Superior Vena Cava. ”