Núñez-Rocha Ricardo E, Gómez-Carrillo Daniel E, Mahecha-Carvajal Mario Enrique, Pérez-Ariza Valentina, Ochoa Diana Lorena, Herrera-Almario Gabriel
School of Medicine, Universidad de los Andes, Bogotá, Colombia.
Department of Diagnostic Imaging, Fundación Santa Fe de Bogotá, Colombia.
Int J Surg Case Rep. 2023 Nov;112:108968. doi: 10.1016/j.ijscr.2023.108968. Epub 2023 Oct 24.
Persistent left superior vena cava (PLSVC) is a rare vascular anomaly that affects systemic venous circulation. PLSVC typically is asymptomatic as the return of venous blood to the right atrium occurs through the coronary sinus. It is important to possess a comprehensive understanding of drainage as it can present challenges in catheter placement on the right side of the heart, aiming to prevent potential complications.
A 59-year-old female patient presented at the medical service with abdominal distention. During the examination, the presence of ascites was observed. Subsequent studies revealed peritoneal carcinomatosis of unknown origin. The patient underwent staging laparoscopy with biopsy sampling. Consequently, the placement of a catheter for chemotherapy was performed. A portable chest X-ray was obtained revealing the catheter extending along the left subclavian vein and progressing through the left paramediastinal regionThe presence of persistent left superior vena cava was confirmed after reviewing prior studies.
The most common abnormality in the venous drainage system is PLSVC. Approximately 40 % of PLSVC cases have associated significant cardiovascular anomalies, with septal defects being the most common. Recognizing anomalies and anatomical variants with the involvement of a multidisciplinary team is critical to prevent vascular complications during endovascular procedures and to tailor techniques for patients in need of cardiac endovascular procedures or cardiac devices.
PLSVC is often asymptomatic and discovered incidentally, it is essential to have a comprehensive understanding of this anomaly and perform meticulous imaging workup to prevent potential complications.
永存左上腔静脉（PLSVC）是一种影响体循环静脉的罕见血管异常。PLSVC通常无症状，因为静脉血通过冠状窦回流至右心房。全面了解其引流情况很重要，因为这可能给心脏右侧的导管置入带来挑战，目的是预防潜在并发症。
一名59岁女性患者因腹胀前来就医。检查时发现有腹水。后续研究显示为不明来源的腹膜癌。患者接受了分期腹腔镜检查及活检取样。随后进行了化疗导管置入。获取的便携式胸部X线片显示导管沿左锁骨下静脉延伸并穿过左纵隔区域。经查阅既往研究后证实存在永存左上腔静脉。
静脉引流系统最常见的异常是PLSVC。约40%的PLSVC病例伴有显著的心血管异常，其中最常见的是间隔缺损。多学科团队参与识别异常和解剖变异对于预防血管内操作期间的血管并发症以及为需要心脏血管内操作或心脏装置的患者调整技术至关重要。
PLSVC通常无症状且多为偶然发现，全面了解这种异常并进行细致的影像学检查以预防潜在并发症至关重要。
