CTICasesPersistent Left Superior Vena Cava Draining directly into the Left Atrium
Imaging findings
Timing bolus chest CT images after left-arm injection demonstrate bilateral superior vena cavae (SVCs) with immediate opacification of the left atrium and aorta first, before systemic recirculation. The delayed phase confirms a persistent left SVC draining directly into the roof of the left atrium rather than the coronary sinus, which is absent or severely diminutive.
Key takeaways
A persistent left SVC draining directly into the roof of the left atrium (often associated with an unroofed or absent coronary sinus) is a rare congenital anomaly that causes a right-to-left shunt and systemic cyanosis. It may be missed on standard transthoracic echocardiography and should always be excluded by tracing the course of a left SVC to ensure it drains normally into the coronary sinus.
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