Persistent left superior vena cava: chest x-ray and echocardiographic findings.

A 74-year-old woman presented with progressive dyspnea and renal failure. A central line catheter was inserted percutaneously into the left internal jugular vein in the emergency department. A chest X ray was performed to document the position of the central line catheter (Fig. l), and revealed an unusual coarse, suggesting the possibility of a persistent left superior vena cava (PLSVC). After admission to the intensive care unit, transthoracic echocardiography with peripheral saline contrast injection in the right antecubital vein (Fig. 2), and also the left antecubital vein (Fig. 3), was performed. Injection of saline contrast into the right antecubital vein documented contrast entering the right atrium via the normal left superior vena cava. However, injection of saline contrast into the left antecubital vein resulted in contrast first appearing in the coronary sinus, followed by the right atrium.