# A rare case of isolated persistent left superior vena cava diagnosed by echocardiography

## TL;DR

A rare case of a persistent left superior vena cava was diagnosed using echocardiography in a 35-year-old man.

## Contribution

This case highlights the diagnostic value of echocardiography in identifying isolated persistent left superior vena cava.

## Key findings

- Echocardiography revealed an enlarged coronary sinus and confirmed isolated PLSVC.
- Agitated saline injection confirmed drainage via the left superior vena cava into the coronary sinus.
- The case underscores the clinical importance of recognizing this rare vascular anomaly.

## Abstract

The persistent left superior vena cava (PLSVC) is an infrequent vascular variant. PLSVC with absent right superior vena cava, also known as isolated PLSVC, is an exceptionally rare entity. In this case we present a patient with isolated PLSVC draining to coronary sinus, diagnosed incidentally during echocardiography.

A 35-year-old man underwent a transthoracic echocardiography which showed an enormously dilated coronary sinus. Hand-agitated saline was injected via peripheral intravenous cannulas. The contrast appeared firstly in the coronary sinus before it opacified the right atrium. Since this was also visible by the right antecubital saline injection, it indicated an extremely rare case of PLSVC with the absence of right superior vena cava which was confirmed by cardiac magnetic resonance.

The finding of a distinctively dilated coronary sinus in echocardiography led us to further investigation using agitated saline that revealed an infrequent anomaly termed isolated PLSVC. The in-depth diagnosis of this vascular variant is crucial considering that it may lead to important clinical implications, such as difficulties with central venous access, especially in the current era of a rapid development of cardiac device therapies.

The online version contains supplementary material available at 10.1186/s13019-024-02709-8.