Multiple thromboembolic events associated with bilateral superior vena cava and anomalous drainage into the left...

Area of Science:

• Cardiology
• Vascular Anatomy
• Hematology

Background:

• A 49-year-old female presented with acute-on-chronic chest pain.
• She had a history of sickle cell trait, a condition affecting red blood cells.
• The patient was diagnosed with multiple systemic thromboemboli, indicating widespread blood clotting.

Observation:

• Cardiac magnetic resonance imaging revealed bilateral superior vena cava (SVC).
• The right SVC anomalously drained into the left atrium, creating a small right-to-left shunt.
• A persistent left SVC drained into the right atrium via a dilated coronary sinus.

Findings:

• The patient's multiple thromboembolic events, including myocardial infarctions and stroke, were attributed to recurrent paradoxical emboli.
• Anomalous venous anatomy, specifically bilateral SVC, was identified as the cause of the paradoxical emboli.
• Sickle cell trait was considered a contributing factor to thrombophilia, increasing clotting risk.

Implications:

• This case highlights the importance of recognizing rare venous anomalies in the diagnosis of recurrent thromboembolic disease.
• Understanding the interplay between congenital vascular variations and hematological conditions is crucial for patient management.
• The findings underscore the need for comprehensive diagnostic approaches in patients presenting with unexplained systemic emboli.