Persistent Left Superior Vena Cava

[Skialta]

I was doing a port placement today on a teen who ended up having a PLSVC. Wondering how many of you guys have seen this, and in your experience did you find it drained into coronary sinus or directly into Left atrium. I read it occurs in 0.3% of population but the anesthesiologist thought it was higher. It was a little freaky to watch on floro, ended up getting a gas to make sure it was venous and not in the aortic arch.

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[surg]

I saw this once when a junior resident showed me a CXR after a swan placement that was wedging properly but the film was "weird" It went through the coronary sinus from the LSVC. Definitely threw me off when they pulled up the film to show me.

 

[Lioness]

I saw it once as a med student on medicine... young guy with a PLSVC that drained into an unroofed coronary sinus. He also had a patent sinus venosus (ASD) and something else I don't remember. As I recall he came into the ED complaining of eye pain and visual defects, and ophtho did a bunch of vitreous cultures and intra-orbital antibiotic and antifungal infections. A few days later he was finally diagnosed with orbital artery emboli from an asymptomatic upper extremity DVT at the site of a previous central line/PICC line (he had been in a bad car accident, broken both legs, etc. several months earlier and treated at another hospital.)

We ended up getting a cardiac MRI on him and it was the weirdest anatomy I've seen.

 

[sleeping]

Saw one when placing a ivc filter Left svc went thru the coronary sinus. Scared the crap out of me wasn't sure if we were putting the filter in the aorta or not. Had to go back to previous cat scans to make sure.

 

[fishmonger69]

saw one at the VA recently. resident on another service placed a left IJ. pressure c/w normal CVP. was a little more 'red' than venous, so blood gas drawn. PO2 was higher than PO2 @ left radial line. guy was whisked to radiology for venogram showing filling @ left atrium --> left ventricle and out to the arch. line was still pulled out.

 

[FliteSurgn]

I've seen it once. Surprisingly, it apparently has an incidence of 1% of the population. Considering that I've done almost 1000 central venous access procedures, you'd think I'd see it more.

 

[Mango]

While moonlighting, I was asked to place a new CVC in a fresh open heart pt. Did a left subclavian, one stick, dark non-pulsitile blood = no problem (I thought). I get the CXR and see the line going straight down, never crossing midline, and looks to be in the arch. After changing my scrubs, I call and have the RN transduce it, which looks venous. I still cannot be sure, so I send a gas which is clearly venous.

I called the NP on the srvice to tell her not to freak when she sees the odd CXR and she says - oh yeah, I was supposed to tell you that in the OR they found that she had a left SVC! Thanks, that info would have been nice to know from the outset!

 

[Mango]

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