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Cardiovascular Images

Absent Right Superior Vena Cava

Multimodality Imaging of Upper Body Venous Drainage via Left-Sided Superior Vena Cava and Azygos Venous System

Simon T. MacDonald, BMBCh, MRCP; Yaso Emmanuel, MBChB, MRCP; Saul Myerson, MD, MRCP; Bernard Prendergast, MD, FRCP; Stefan Neubauer, MD, FRCP and Paul Leeson, PhD, MRCP

From the Oxford Centre for Clinical Magnetic Resonance Research and the Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom.

Correspondence to Simon MacDonald, BMBCh, MRCP, Department of Cardiology, John Radcliffe Hospital, Oxford, OX3 9DU, UK. E-mail stmacd@gmail.com

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 63-year-old man was referred for cardiac evaluation after a chest radiograph for an upper respiratory tract infection demonstrated prominent mediastinal borders (Figure 1). He had a normal clinical examination. A dilated coronary sinus was identified on transthoracic echocardiography. On subsequent transesophageal echocardiography, agitated saline contrast injected into the left antecubital vein first appeared in the coronary sinus, consistent with a persistent left-sided superior vena cava (Figure 2A and Movie 1). Interestingly, saline injected into the right antecubital vein also first appeared in the coronary sinus (Figure 2B and Movie 2). Imaging of the atria confirmed the absence of a right superior vena cava (Figure 2C). Cardiovascular MRI demonstrated that blood from the right side of the body passed via an innominate vein, anterior to the aortic arch (Figure 3A), to the left-sided superior vena cava (Figure 3B and 3C and Movie 3) and then, via the dilated coronary sinus, into the right atrium (Figure 3D and Movie 4). There was also drainage via a prominent left-sided azygos venous system (Figure 4). The aorta was normal and left-sided. There was no left-to-right intracardiac shunt, and pulmonary venous drainage was normal.

Absence of the right superior vena cava is rare. During development, blood usually passes preferentially to the right-sided cardinal venous system via a vessel between the anterior cardinal veins that becomes the left brachiocephalic vein. The left-sided veins involute to become the coronary sinus . . . [Full Text of this Article]