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Dense Coronary Sinus: A Sign of Left Superior Vena Cava on Abdominopelvic CT

University of South Dakota School of Medicine Sioux Falls, SD 57105

Persistence of the left superior vena cava (LSVC) draining into the right atrium via the coronary sinus is a variation of normal systemic venous return, occurring in 0.3% of the general population [1]. Its prevalence is much higher in patients with congenital cardiac abnormalities, ranging from 2.8% to 4.3% of this population [2]. The LSVC forms from a confluence of the left subclavian and left jugular veins and courses inferiorly in a position analogous to that of the normal superior vena cava on the right side. Inferiorly, the LSVC lies anterior relative to the left hilum and usually drains into a markedly dilated coronary sinus. The clinical significance of this anomaly is minimal unless there is an associated atrial septum defect, with a resultant left-to-right shunt. The anatomic course of the LSVC reflects retention of the embryologic left anterior and common cardinal veins and the left horn of the sinus venosus, structures that ordinarily regress. In a patient with an LSVC, a right superior vena cava may or may not be present [3]. The appearance of an LSVC on chest CT has been previously described [4]. We present a finding on abdominopelvic CT that we believe should be considered, if not diagnostic, at least suggestive of the presence of an LSVC.

Our patient was a 60-year-old woman whose WBC had been increasing since she underwent a right hemicolectomy for colon cancer. She presented for abdominopelvic CT using oral and IV contrast materials. The coronary sinus was noted to be densely opacified with contrast material, much more so than either adjacent ventricle (Fig. 2A). The remainder of the examination was unremarkable. On the basis of this finding, we suspected that an LSVC was present, and indeed the presence of this structure was confirmed several days later when a central catheter for medications was placed. Because the left subclavian catheter took a course typical of an LSVC, the referring service requested an injection of contrast material. Angiography showed an immediate opacification of the coronary sinus from the catheterized LSVC (Fig. 2B).

View larger version (138K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A. —60-year-old woman with history of colon cancer and increasing WBC. Contrast-enhanced abdominopelvic CT scan reveals coronary sinus to be densely opacified with contrast material, much more so than either adjacent ventricle.

View larger version (157K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B. —60-year-old woman with history of colon cancer and increasing WBC. Digital subtraction angiogram shows left subclavian triple lumen contrast injection immediately opacifying coronary sinus.

To our knowledge, diagnosing a case of LSVC using abdominopelvic CT has not previously been reported. Any variation in the appearance of contrast material in cardiac chambers from the expected sequence should raise suspicions of a vascular anomaly or abnormality. In conclusion, a densely opacified coronary sinus visible on the upper portions of abdominopelvic CT scans raises the possibility of an LSVC and, in the proper clinical setting, should prompt further imaging to exclude the presence of other abnormalities.

References

1. Sanders JM. Bilateral superior vena cava. Anat Rec 1946;94:657 -659
2. Campbell M, Deuchar DC. The left-sided superior vena cava. Br Heart J 1954;16:423
3. Naidich DP, Zerhouni EA, Siegelman SS. Computed tomography of the thorax, 1st ed. New York: Raven, 1984: 34-38
4. Huggins TJ, Lesar ML, Friedman AC, Pyatt RS, Thane TT. CT appearance of persistent left superior vena cava. J Comput Assist Tomogr 1982;6:294 -297[Medline]

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This Article Figures Only Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Eidsness, W. R. Articles by Benzmiller, P. G. Search for Related Content PubMed PubMed Citation Articles by Eidsness, W. R. Articles by Benzmiller, P. G. Social Bookmarking                      What's this?