Bilateral superior vena cava with contralateral atrial drainage with brain abscess and transient ischemic attack in adult patient

Abstract

Structured abstract Objectives: Rare case of bilateral superior vena cava (SVC) with contralateral atrial drainage in an adult patient with brain abscess and transient ischemic attack diagnosed with cardiac magnetic resonance imaging (MRI). Background: Anomalous systemic venous return is a variable congenital malformation. Furthermore, the consequence of anomalous systemic venous return is also variable. Prior literature has documented drainage of superior vena cava to the left atrium, with right to left shunting. We report a case of bilateral SVC with contralateral atrial drainage in an adult patient. The consequence of the right to left shunt resulted in brain and frequent episodes of transient ischemic attack (TIA). Methods: Evaluation of echocardiography and cardiac MRI demonstrated bilateral SVC with contralateral atrial drainage. Results: Transthoracic echocardiogram revealed dilated coronary sinus. Agitated saline bubble contrast study from right upper extremity showed immediate opacification of the left cardiac chambers suggestive of right SVC draining to left atrium. Transesophageal echocardiogram confirmed dilated coronary sinus; agitated saline contrast injection from left arm revealed complete opacification of the coronary sinus followed by opacification of the right heart, consistent with the presence of the left sided SVC draining to dilated coronary sinus. Cardiac MRI confirmed right SVC draining to the left atrium and the left SVC draining to the right atrium. Conclusions: Anomalous systemic venous return is a relatively common and variable congenital malformation with heterogeneous consequences. Anomalous drainage of systemic venous return to the left atrium is an unusual variant of systemic venous return anomalies, which is characterized by right-to-left shunt. We present extremely rare case of bilateral SVC draining into contralateral atrium, resulting in a right-to-left shunt. This right-to-left shunt can result in persistent hypoxemia, mild cyanosis, paradoxical embolism with brain abscess. Patients may also remain asymptomatic. With accurate diagnosis, this condition can be treated with good short-term results. abstract Anomalous systemic venous return is a variable congenital malformation. Furthermore, the consequence of anomalous systemic venous return is also variable. Prior literature has documented drainage of superior vena cava (SVC) to the left atrium, with right to left shunting [1-3]. We report extremely rare case of bilateral superior vena cava with contralateral atrial drainage in an adult patient. The consequence of the right to left shunt in this patient resulted in brain abscess as well as frequent episodes of transient ischemic attack.