PMC9619296_01
Transthoracic echocardiogram, parasternal long axis view, illustrating a dilated coronary sinus (CS).
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Transthoracic echocardiogram (TTE) was performed to evaluate the right heart as part of the pre-surgical work-up which end up revealing a dilated coronary sinus leading to suspect a PLSVC (Fig. 1).
Injection of agitated saline in the left arm with bubbles (yellow arrow) appearing first in the coronary sinus (A), and later into the right atrium. (B) Coronary sinus draining into an enlarged right atrium.
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Following the trajectory of the saline solution, as it went through an abnormal sequence; a clear inflow of the solution in the coronary sinus first then in the right heart chambers (Fig. 2).
Bubble study showing the normal connection of right superior vena cava (RSVC) by early appearance of saline contrast in the right ventricle (RV) (yellow arrow) -right arm injection (parasternal long axis view).
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Whereas the right superior vena cava drains directly into the right atrium as shown by the contrast injection in the right antecubital vein (Fig. 3).
CT angiogram of chest in axial section (A), sagittal reformatted scan (B), and coronal reformatted scan (C), showing a vascular structure following the left subclavian vein (Fig. 2A). This structure, descending along the left side of the aortic arch (Fig. 4B), consistent with PLSVC (Yellow arrow). Note the right superior vena cava in place (Fig. 2C) (Red arrow).
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PLSVC (Fig. 4), a collateral was present connecting it to the right superior vena cava (Fig. 5). Parenchymal window shows a destroyed right lung with foci of dilated supra infarcted branches (Fig. 6).
Angio computed tomographic scan of chest in the parenchyma window, in axial section (A), and coronal reformatted scan (B), showing destroyed right lung with foci of dilated supra infarcted branches.
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PLSVC (Fig. 4), a collateral was present connecting it to the right superior vena cava (Fig. 5). Parenchymal window shows a destroyed right lung with foci of dilated supra infarcted branches (Fig. 6).