Persistent left superior vena cava with absent right superior vena cava and coronary sinus dilation mimicking a paracardiac mass.

Abstract

A 54-year-old man was referred to our hospital due to atypical chest pain and a suspected paracardiac mass. Cardiac examination revealed a grade 1/6 systolic murmur in the left parasternal border. Results of surface electrocardiography and laboratory examinations were within normal limits. Transthoracic (Fig. 1) and transesophageal echocardiography showed the absence of a right superior vena cava (SVC), the presence of a left SVC at the lateral border of the left atrium, and no other structural abnormalities. The diagnosis was confirmed on computed tomography (CT) (Fig. 2). The patient's visceral organs were normally positioned and structured. Coronary angiography and cardiac catheterization revealed normal coronary arteries and no stenosis. Upper-extremity and cranial veins drained into the coronary sinus via the persistent left SVC; therefore, the coronary sinus was approximately 5 cm in diameter and mimicked a paracardiac mass (Fig. 3). Fig. 1 The dilated coronary sinus (arrows) resembles a paracardiac mass, as shown on transthoracic 2-dimensional echocardiography in the apical 5-chamber view. Ao = aorta; LA = left atrium; LV = left ventricle Fig. 2 Computed tomography of the chest shows the persistent left superior vena cava (arrow) next to the aortic arch (Ao). Fig. 3 Coronary sinus angiography shows retrograde opacification via the coronary sinus of the persistent left superior vena cava in the left lateral thorax.