VIEWS: 12 PAGES: 3 CATEGORY: Medicine POSTED ON: 6/18/2010
[...] following nontherapeutic visceral angiography, the TLC was injected with radiocontrast for digital subtraction angiography (DSA). Clinically, a marked left jugular venous pulsation may be present on physical examination.1 Plain radiographs may demonstrate a widened mediastinum with a shadow or soft tissue density between the aortic arch and the middle third of the clavicle.1 As a result, PLSVCs are often misdiagnosed as catheter placement in the subclavian artery or the mediastinal, pericardial, or pleural space.1 The correct diagnosis is often made only after TLC or pulmonary artery catheter (PAC) placement.
DxImaging0909.qxp 8/25/09 9:40 AM Page 60 Diagnostic Imaging Review G I N A LU C K I A N O W, PA- C ; D E B O R A H C O L E , PA- C , M M S c ; L E W I S J . K A P L A N , M D, FA C S , F C C M , F C C P ›DISCUSSION The patient was urgently taken to inter- ventional radiology (IR) for visceral angiography and possible embolization. While she was in IR, radiologic review of the radiograph noted that the tip of the left subclavian TLC resided to the left of the mediastinum and that the TLC was pulsing in time with the car- diac cycle. These observations raised two possibilities: arterial, not venous insertion, or a persistent left-sided supe- rior vena cava (PLSVC). Accordingly, following nontherapeutic visceral an- giography, the TLC was injected with radiocontrast for digital subtraction an- giography (DSA). The DSA confirmed venous insertion of the TLC via the subclavian vein into a PLSVC that FIGURE 1 drained into the right atrium. Left subclavian Origin of an anomaly A PLSVC is triple-lumen catheter the most common vascular anomaly in placement the thorax and is identified in approxi- mately 0.3% to 0.5% of the general population.1 A higher incidence is noted in 3% to 5% of patients with con- Anatomical variant found genital heart disease, principally those with septal defects.2,3 during catheter insertion A PLSVC stems from the failure of the left cardinal vein to degenerate. In the embryonic venous system, paired anterior cardinal veins drain blood from ›CASE
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