Persistent left superior vena cava: diagnosed by bedside echocardiography in a liver transplant patient: a case report

Abstract

In most cases, persistent left superior vena cava (PLSVC) is asymptomatic and discovered accidentally. This case involves a 43-year-old male who underwent an emergency cadaveric liver transplantation. Postoperatively, the left internal jugular vein was cannulated using a sono-guided Seldinger technique in the intensive care unit. But the chest X-ray showed that the catheter followed the left paramediastinal course instead of crossing midline to the right to enter the superior vena cava. In consideration of the patient's status, an intra-arterial or extra-vascular placement could be excluded. For a diagnosis, we performed a bed-side transthoracic echocardiography with an agitated saline micro-bubble test. When agitated saline was injected through the catheter, the coronary sinus was initially opacified, and then the right atrium followed. In conclusion, we were able to make a diagnosis of PLSVC by a bedside test without radiation exposure.

Keywords: Congenital heart defects; Contrast media; Diagnostic use; Echocardiography.

Fig. 1

The left internal jugular catheter (Black arrows) lied along the left paramediastinal border unusually and the chest tube (White arrows) inserted in the left pleural cavity are shown on this radiograph.

Fig. 2

By injecting agitated saline through the left internal jugular catheter, air-bubble opacification was observed at the coronary sinus (CS), right atrium (RA), and right ventricle (RV), sequentially, in an apical 4-chamber view by transthoracic echocardiography. (A) pre-saline injection, (B) early period after saline injection, (C) late period after saline injection, (D) a dilated coronary sinus by parasternal long-axis view. Ao: aorta, LA: left atrium, LV: left ventricle.