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Case Reports
. 2021 Feb 1;14(2):e237401.
doi: 10.1136/bcr-2020-237401.

Multiple thromboembolic events associated with bilateral superior vena cava and anomalous drainage into the left atrium

Maria Elizabeth Karavassilis  1 , Michael Haji-Coll  2 , Niall G Keenan  3
Affiliations
Case Reports

Multiple thromboembolic events associated with bilateral superior vena cava and anomalous drainage into the left atrium

Maria Elizabeth Karavassilis et al. BMJ Case Rep. .

Abstract

A 49-year-old female patient presented with acute-on-chronic chest pain. She was diagnosed with multiple systemic thromboemboli, including myocardial infarctions, bilateral chronic pulmonary emboli, ischaemic stroke, deep venous thrombosis and superficial thrombophlebitis. She had a background of sickle cell trait. Cardiac magnetic resonance showed bilateral superior vena cava (SVC). The right-sided SVC (RSVC) was joined by the right upper pulmonary vein and drained anomalously into the left atrium. This caused a small volume right to left shunt. The persistent left SVC drained into the right atrium (RA) via a dilated coronary sinus. The overall clinical impression was recurrent paradoxical emboli due to anomalous venous anatomy with a thrombophilia secondary to sickle cell trait. In the normal embryo, the right common cardinal vein develops to become the RSVC, which drains into the RA by term.

Keywords: clinical diagnostic tests; haematology (incl blood transfusion); radiology; radiology (diagnostics); venous thromboembolism.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Transthoracic echocardiogram (lesion indicated with arrows). (A) Parasternal long axis view: arrowhead pointing to the dilated coronary sinus. (B) Two-chamber view: arrowhead pointing to the dilated coronary sinus. (C) Modified right ventricular inflow view: arrowhead pointing to the ostium of the dilated coronary sinus. (D) Right clavicle view: arrowhead pointing to the right-sided superior vena cava (RSVC). (E) Left clavicle view: arrowhead pointing to the left-sided superior vena cava (LSVC). (F) Left clavicle view: arrowhead pointing to the LSVC.
Figure 2
Figure 2
Cardiac MRI: Late phase after gadolinium contrast showing an area of subendocardial myocardial infarction in the basal inferolateral left ventricle.
Figure 3
Figure 3
Cardiac MRI (lesions indicated with arrows): (A) Four-chamber view: still image from steady state-free precession (SSFP) cine showing a dilated coronary sinus. (B) Two-chamber view: still image from SSFP cine showing a dilated coronary sinus. (C) Three-chamber view: still image from SSFP cine showing a dilated coronary sinus.
Figure 4
Figure 4
Cardiac MRI CT MPR (multiplanar reconstruction) showing the right-sided superior vena cava (SVC) entering the left atrium (arrow), and an anomalous right upper pulmonary vein entering the right-sided SVC (arrowhead).
Figure 5
Figure 5
Cardiac MRI transaxial stack of bright blood steady state-free precession (SSFP) images showing the eft-sided superior vena cava (SVC) draining into dilated coronary sinus (arrow) and right-sided SVC being joined by anomalous right upper pulmonary vein (third panel) and draining into the left atrium (fifth panel) (arrowhead).
See this image and copyright information in PMC

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