Ann Clin Neurophysiol.  2018 Jul;20(2):105-108. 10.14253/acn.2018.20.2.105.

Acute pontine infarction in a patient with persistent left superior vena cava

• Jeong DE
• Lee J
• Hwang W

• KMID: 2454715
• DOI: http://doi.org/10.14253/acn.2018.20.2.105

Abstract

Persistent left superior vena cava (PLSVC) is a common venous anomaly of the thorax and usually drains into the right atrium. Less often it drains into the left atrium and has previously been related to ischemic stroke. We report a case of PLSCV that founded during ischemic stroke evaluation in a 77-year-old woman which was detected on transesophageal echocardiography (TEE) and transcranial Doppler ultrasonography (TCD) with saline agitated test and computed tomography.

Keyword

Persistent left superior vena cava; Cerebra infarction; Saline agitation test; Paradoxical embolism; Transcranial Doppler ultrasonography; Transesophageal echocardiography

MeSH Terms

Aged
Dihydroergotamine
Echocardiography, Transesophageal
Embolism, Paradoxical
Female
Heart Atria
Humans
Infarction*
Stroke
Thorax
Ultrasonography, Doppler, Transcranial
Vena Cava, Superior*
Dihydroergotamine

Figure

• 

  Fig. 1 Brain magnetic resonance imaging (MRI) was performed 10 hours after symptom onset (A, diffusion weighted image [DWI]-MRI; B, apparent diffusion coefficient [ADC]). Focal high signal intensity lesion are observed in the left upper pons on DWI and their corresponding low-signal lesion on ADC map.

• 

  Fig. 2 Transesophageal echocardiography (bicaval view) of the patient. (A) Saline bubble saturation of the left heart chamber became noticeable after agitated saline was applied into the left antecubital vein. that the bubbles originated not from the interatrial septum but from the LPV. (B) Modified aortic valve short axis view (51°) showing the bubble in the LA without PA saturation. (C) Computed tomography of the chest. The reconstructed images using volume rendering demonstrate that the persistent left superior vena cava (white arrow) originates from the left brachiocephalic vein and drains into the left upper pulmonary vein, which leads directly into the left atrium. RA, right atrium; LA, left atrium; LPV, left pulmonary vein; Ao, aorta; PA, pulmonary artery; BCV, brachiocephalic vein.

• 

  Fig. 3 Transcranial Doppler ultrasonography was performed on the ninth day of admission. Injection of agitated saline with microbubbles through the left brachial vein shows a curtain of microembolic signals.

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