Right-sided superior vena cava draining into the left atrium: a rare anomaly of systemic venous return

Pediatr Radiol (2007) 37:317320 DOI 10.1007/s00247-006-0389-6

CASE REPORT

Right-sided superior vena cava draining into the left atrium: a rare anomaly of systemic venous return

Shadi Aminololama-Shakeri &

Sandra L. Wootton-Gorges & Robert K. Pretzlaff &

Melissa Reyes & Elizabeth H. Moore

Received: 29 September 2006 / Revised: 14 November 2006 / Accepted: 29 November 2006 / Published online: 4 January 2007 # Springer-Verlag 2007

Abstract The most commonly encountered systemic thoracic venous anomaly is a persistent left superior vena cava that drains into the right atrium via the coronary sinus. A much rarer systemic venous anomaly is that of isolated anomalous drainage of a normally positioned right superior vena cava (RSVC) into the left atrium (LA). This has been reported in approximately 20 patients with the diagnosis usually being made by cardiac catheterization. We report the case of a toddler with asymptomatic hypoxemia resulting from anomalous drainage of a normal RSVC into his LA. This was diagnosed non-invasively by contrast-enhanced chest CT.

Keywords Systemic vein . Congenital anomaly . CT . Chest . Pediatric

Introduction

The most commonly encountered systemic thoracic venous anomaly is a persistent left superior vena cava (LSVC) with

anomalous drainage into the right atrium (RA) via the coronary sinus. The latter is frequently accompanied by other cardiac malformations such as an atrial septal defect. A much rarer systemic venous anomaly is that of isolated anomalous drainage of a normally positioned right superior vena cava (RSVC) into the left atrium (LA), creating a right-to-left shunt. This rare anomaly has been reported in approximately 20 patients with atrial situs solitus [1, 2]. Most of these patients were only minimally symptomatic with mild cyanosis. The diagnosis was usually made by cardiac catheterization and was occasionally suggested by echocardiogram or nuclear imaging.

We report the case of a toddler with anomalous drainage of a normal RSVC into his LA diagnosed non-invasively by contrast-enhanced chest CT.

Case report

A previously healthy 21-month-old boy was brought to medical attention following the ingestion of one of his grandmothers glyburide tablets. Upon arrival at an outside medical facility, he was noted to have a blood sugar level of 53 mg/dl. While being treated for hypoglycemia, his oxygen saturation was noted to be 7080%, despite treatment with supplemental oxygen. Arterial...