IS Case 281: Duplicated superior vena cava (SVC) with central line

A. R. Klekers, MD

URMC Imaging Sciences

Imaging Sciences URMC 2009
Publication Date: 2009-08-05

History

Patient is a 74-year-old female requiring tunneled central line placement for hemodialysis

Findings

Tunneled central line placed in left duplicate superior vena cava (SVC).

Diagnosis

Duplicated superior vena cava (SVC) with central line

Discussion

Left superior vena cava (SVC) is most often an incidental finding seen in less than 0.5% of the general population and in 4% of patients with congenital cardiac disorders. Frequently a left SVC is a part of a duplicated SVC. In these cases the right SVC is usually smaller and there is absence of left brachiocephalic vein. In cases where there is no congenital heart disease the left component of duplicated SVC usually drains into the coronary sinus. It may drain into the left atrium in cases of congenital heart disease. The left SVC passes lateral to the aortic arch and anterior to the hilum. It then drains into the coronary sinus which is often enlarged.

Left SVC is best diagnosed by CT or MRI. Sometimes focal widening of the mediastinum on the superior left aspect adjacent to the aortic knob may be seen on x-ray. Most often this entity is seen radiographically when traversed by a catheter.

References

1. Demos TC, Posniak HV, Pierce KL, Olson MC, Muscato M. Venous anomalies of the thorax. AJR Am J Roentgenol. 2004 May;182(5):1139-50. PMID: 15100109 [PubMed]