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Case 71

Left sided SVC

A CT for staging oesophageal carcinoma

This elderly patient presented with dysphagia from a low oesophageal carcinoma. This CT scan was performed to stage the disease, and the dilated proximal oesophagus can be seen in the posterior mediastinum, along with some fluid within a fissure in the right hemithorax.

Findings

The superior vena cava is not present in its usual location to the right of the ascending aorta. There is an enhancing structure to the left of the aortic arch which is clearly a vessel. There is not normally any soft tissue structure (other than fat) in this location.

This structure runs inferiorly to enter the coronary sinus, which on the third image is seen to course behind the left ventricle and drain into the right atrium (The third image has now been labelled).

Diagnosis

Persistant left sided superior vena cava, with absence of the right superior vena cava.

Discussion

This variant occurs as a result of persistence of the left anterior cardinal vein. The right SVC often persists, but may be absent, as in this case. The incidence is approximately 0.5%. It typically drains via the coronary sinus.

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