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Paradoxical emboli from left superior vena cava causing recurrent brain abscess.
1Department of Cardiothoracic Surgery, National Heart Centre Singapore, 17 Third Hospital Avenue, Singapore. zackkk18@yahoo.com
Singapore Medical Journal
|January 19, 2012
Summary
Persistent left superior vena cava, a rare anomaly, can lead to paradoxical emboli and brain abscess. Surgical ligation effectively treated a patient with this condition, resolving recurrent abscesses.
Area of Science:
- Cardiovascular Medicine
- Anatomical Variations
- Neurology
Background:
- Persistent left superior vena cava (PLSVC) is an uncommon congenital anomaly.
- It involves the persistence of the embryonic left superior vena cava instead of the right.
- This anomaly can lead to significant clinical complications if not recognized.
Observation:
- A case is presented of PLSVC draining directly into the left atrium.
- This anatomical variation resulted in a fixed right-to-left shunt.
- The patient experienced recurrent brain abscesses due to paradoxical embolic events.
Findings:
- The direct drainage of PLSVC into the left atrium created a persistent intracardiac shunt.
- Paradoxical embolism, where clots travel from the venous to the arterial system, was identified as the cause of recurrent brain abscesses.
- Diagnostic imaging confirmed the anatomical abnormality and embolic source.
Implications:
- This case highlights the critical importance of recognizing PLSVC in patients with cryptogenic stroke or recurrent embolic events.
- Surgical intervention, specifically ligation of the anomalous vessel, can be a curative treatment for associated complications.
- Understanding this rare anomaly is crucial for accurate diagnosis and effective management of paradoxical embolic phenomena.
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