Right-sided superior vena cava draining into the left atrium in a patient with persistent left-sided superior vena cava emptying into the right atrium diagnosed by echocardiography

Anomalous systemic venous connection with the left atrium (LA) is an unusual congenital cause of a right-to-left shunt. It is most commonly due to a persistent left-sided superior vena cava (SVC) draining into the LA (1). Less commonly, the right-sided SVC may drain into the LA. This occurrence is rare in the absence of other cardiac abnormalities (2). Here we present a rare cardiac congenital anomaly with double SVC drainage, with a right-sided SVC emptying into the LA and a persistent left-sided SVC emptying into the right atrium (RA).

CASE PRESENTATION

A 65-year-old man presented to the emergency department with a sudden onset of speech disturbances and left arm weakness. He was known to have had hypertension, pancreatitis, migraines, hyperlipidemia, and a cerebral brain abscess drained at the age of 22, resulting in a seizure disorder. He was not cyanotic. Due to his sudden onset of stroke symptoms, a transthoracic echocardiogram with agitated saline was done. A peripheral intravenous line in the patient's right antecubital vein was used to inject agitated saline and evaluate for intracardiac shunting. During echocardiographic imaging, the agitated saline immediately entered...