View Abstract

A3498 - Double SVC Syndrome
Author Block: A. Adial1, A. Iftikhar2, S. Beri3, P. Upadhyaya4, H. Patel5; 1Pulmonary, NYPQ, Flushing, NY, United States, 2feinstein institute, Northwell Health, Manhasset, NY, United States, 3Critical Care, New York, NY, United States, 4Infectious Disease, Stanford University, Palo Alto, CA, United States, 5Medicine, Kings brook Jewish Medical Center, Brooklyn, NY, United States.
Introduction:
Persistent left superior vena cava is the most common thoracic venous anomaly. The incidence of double SVC in general population is 0.3% whereas in patients with congenital heart disease it varies between 10-11%. The superior vena cava (SVC) carries deoxygenated venous blood from the upper half of the body to the right atrium. Congenital variants of the SVC can be incidental, may be associated with cardiac anomalies or syndromes, and may first be identified at imaging performed for venous access or other purposes. The direct visualization of the SVC is better obtained at computed tomography or magnetic resonance imaging. We are presenting a case in which we found incidental double SVC after putting triple lumen catheter.
Case:
69 y/o male with history of CHF admitted due to septic shock due to perforated gangrenous cholecystitis, requiring mechanical ventilation and vasopressors. Triple lumen catheter was placed in ICU, found to have misplaced catheter on chest x-ray. Patient had a previous CT chest image, found to have double SVC. Patient refused for any type of surgical intervention. Patient got better with conservative management only.
Discussion:
Persistent left sided superior vena cava (SVC) is the most common thoracic anomaly, presents only in 0.3-0.5 % of the general population. In the absence of other congenital cardiac anomalies, is almost never diagnosed because it tends to be hemodynamically insignificant, rarely leading to symptoms. The cause of persistent left SVC is persistence of the left anterior cardinal vein, left common cardinal vein, and left horn of the sinus venosus. Often the first clue to this anomaly is the unexpected course of a central venous catheter (CVC) along the left mediastinal contour on Chest x-ray. The CVC placement in the left SVC may be mistaken for arterial, mediastinal, or pleural placement on a frontal chest radiograph. Except in cases where a large right to left shunt is present, a left sided SVC has essentially no physiologic impact and is entirely asymptomatic. Diagnosis can be confirmed with CT of the chest with contrast, MRI or transthoracic echocardiography with bubble study.
Conclusion:
Persistent left SVC is most commonly seen as incidental finding while placing CVC or pacemaker. The majorities of patients remain asymptomatic and don’t require any intervention.