Right-to-left anatomic shunt associated with a persistent left superior vena cava: the importance of injection site in demonstrating the shunt.
| Publication Type | Case Report |
| Authors | Thaiyananthan N, Jacono F, Patel S, Kern J, Stoller J |
| Journal | Chest |
| Volume | 136 |
| Issue | 2 |
| Pagination | 617-620 |
| Date Published | 08/01/2009 |
| ISSN | 1931-3543 |
| Keywords | Abnormalities, Multiple, Contrast Media, Coronary Vessel Anomalies, Heart Defects, Congenital, Vena Cava, Superior |
| Abstract | Anatomic right-to-left shunt causes hypoxemia that can pose a diagnostic challenge to clinicians. Among the many possible causes of right-to-left shunt, persistent left-sided superior vena cava (PLSVC) with an "unroofed" coronary sinus represents an uncommon congenital anomaly in which detection by saline-contrast echocardiogram (bubble echo) or contrast-enhanced CT scan requires injection of contrast in the left arm. We present the case of an elderly man with hypoxemia on the basis of a right-to-left shunt accompanying a PLSVC with unroofed coronary sinus in whom the shunt escaped initial detection following a bubble echo with contrast injected into the right arm. This case reminds pulmonary clinicians, who are frequently called on to assess the cause of hypoxemia, that specifying a contrast injection into the left arm is required in the pursuit of this specific shunt-producing anomaly. |
| DOI | 10.1378/chest.08-2641 |
| PubMed ID | 19666762 |