CTICasesAnomalous Right Superior Vena Cava
Imaging findings
Contrast-enhanced chest CT demonstrates bilateral superior vena cavae (SVC). The persistent left SVC drains normally via the coronary sinus into the right atrium. However, the right SVC does not connect to the right atrium, instead draining directly into the roof of the left atrium, creating a congenital right-to-left shunt. An anomalous pulmonary vein is also present. The patient developed a stroke/TIA immediately following a right-arm microbubble saline injection.
Key takeaways
Anomalous drainage of the right superior vena cava directly into the left atrium is an extremely rare congenital systemic venous anomaly. It represents a right-to-left shunt that bypasses the pulmonary filter. The diagnosis is often prompted by systemic hypoxemia, a dilated coronary sinus on echocardiography, or a paradoxical embolic event (such as a stroke or TIA) immediately following intravenous contrast or bubble study injection via the right upper extremity.
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