Case of the Week
Levoatriocardinal Vein with Normal Intracardiac Anatomy: A Case of Misidentification
A 39-year-old male with a history of obesity and poorly controlled essential hypertension presented to the emergency department with chest pain and shortness of breath. A CT angiogram demonstrated normal coronary anatomy. However, a vascular structure was noted coursing from the innominate vein toward the left atrium (Image 1). This was interpreted as a persistent left superior vena cava (LSVC) with intact bridging vein. The patient was referred to a cardiologist for further evaluation of his symptoms and management of his hypertension. 2-dimensional (2D) transesophageal echocardiogram (TEE) demonstrated a structurally normal heart, mild qualitative dilation of the left atrium (LA), and no apparent atrial or ventricular septal defects. There was no significant atrioventricular valve insufficiency. The right ventricle (RV) and left ventricle (LV) were normal in regards to size, global systolic function, and regional wall motion. A bubble contrast study was performed to exclude intracardiac shunting.