Kim Hyerim, Kim Jin Hee, Lee Hannah
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea.
Department of Anesthesiology and Pain Medicine, National University Bundang Hospital, Seongnam, Korea.
Korean J Anesthesiol. 2014 Dec;67(6):429-32. doi: 10.4097/kjae.2014.67.6.429. Epub 2014 Dec 29.
In most cases, persistent left superior vena cava (PLSVC) is asymptomatic and discovered accidentally. This case involves a 43-year-old male who underwent an emergency cadaveric liver transplantation. Postoperatively, the left internal jugular vein was cannulated using a sono-guided Seldinger technique in the intensive care unit. But the chest X-ray showed that the catheter followed the left paramediastinal course instead of crossing midline to the right to enter the superior vena cava. In consideration of the patient's status, an intra-arterial or extra-vascular placement could be excluded. For a diagnosis, we performed a bed-side transthoracic echocardiography with an agitated saline micro-bubble test. When agitated saline was injected through the catheter, the coronary sinus was initially opacified, and then the right atrium followed. In conclusion, we were able to make a diagnosis of PLSVC by a bedside test without radiation exposure.
在大多数情况下，永存左上腔静脉（PLSVC）是无症状的，多为偶然发现。该病例为一名43岁男性，接受了急诊尸体肝移植。术后，在重症监护病房采用超声引导下的Seldinger技术对左颈内静脉进行插管。但胸部X线显示导管沿左纵隔旁走行，而不是穿过中线至右侧进入上腔静脉。考虑到患者的情况，可排除动脉内或血管外放置。为明确诊断，我们进行了床边经胸超声心动图检查并进行了搅动生理盐水微泡试验。当通过导管注入搅动生理盐水时，冠状窦首先显影，随后右心房显影。总之，我们通过床边检查在无辐射暴露的情况下确诊了PLSVC。
