Images in Clinical Medicine
Bilateral Superior Vena Cava
N Engl J Med 2007; 356:1870May 3, 2007
- Article
A 67-year-old man receiving hemodialysis because of kidney failure resulting from renovascular disease was admitted to the hospital for revision of dialysis access. Six months earlier, a dual-chamber, permanent pacemaker had been implanted in the right side of the chest for the treatment of complete heart block. The dialysis catheter, inserted into the left internal jugular vein under fluoroscopic guidance, showed a left superior vena cava draining into the right atrium through a coronary sinus. A chest radiograph showed the pacemaker, with leads in the right subclavian vein and right superior vena cava, and a catheter in the left internal jugular vein and left superior vena cava. Subsequent dialysis was uneventful. The presence of a left superior vena cava is the result of persistence of the embryonic left anterior cardinal vein. It is present in approximately 0.5% of the general population and in 5 to 10% of persons with other congenital heart defects. In 90% of cases in which the left superior vena cava is present, there is drainage through the coronary sinus into the right atrium. The left brachiocephalic vein is usually absent or atrophic, and occasionally the right superior vena cava is absent as well.
Andrew C. Fry, M.R.C.P.
Paul Warwicker, F.R.C.P.
Lister Hospital, Hertfordshire SG1 4AB, United Kingdom
andyfry@doctors.org. uk - Citing Articles (2)
Citing Articles
1
P. Autier, M. Boniol, R. Middleton, J.- F. Dore, C. Hery, T. Zheng, A. Gavin. (2011) Advanced breast cancer incidence following population-based mammographic screening. Annals of Oncology 22:8, 1726-1735
CrossRef2
Stephen P Povoski, Hooman Khabiri. (2011) Persistent left superior vena cava: Review of the literature, clinical implications, and relevance of alterations in thoracic central venous anatomy as pertaining to the general principles of central venous access device placement and venography in cancer patients. World Journal of Surgical Oncology 9:1, 173
CrossRef
