LAUSR

Abnormal embryological developments of the great thoracic veins are rare in particularly the duplication of superior vena cava (SVC) or left persistant superior vena cava. It can be incidentally discovered in the adult during chest radiologic imaging, per operatively or after catheter insertion. A 31-year-old male patient presented to the hospital with recurrent pulmonary infection and hemoptysis. Clinical examination revealed reduced percussion note and breath sounds over the base of the left hemithorax. Chest-X-ray revealed atelectasis of the left lower pulmonary lobe. Computed tomography (CT) of the thorax showed a mass of the left lower lobe (Figure: 1A), with presence of a left superior vena cava associated to a normal right superior vena cava (Figure: 1B). Bronchoscopy revealed an endobronchial bleeding rounded mass at the left lower bronchus, biopsy specimen of the mass and pathological report confirmed the diagnosis of carcinoid tumor. The patient underwent posterolateral thoracotomy, we noted a persistent Left superior vena cava that ends cross-sectionally directly into the atria not through the coronary sinus (CS). (Figure: 1C) peropertively the tumor did have no adherence or contact with the abnormal vena and no other cardiac or extra cardiac anomalies were noted. We performed a left lower lobectomy with lymphadenectomy (Figure: 1D). The pathological analysis of the specimen concluded a diagnosis of typical carcinoid tumor. The postoperative period was uneventful The incidence of double SVC in general population is <0.5% whereas in patients with congenital heart disease it varies between 10–11%. In the most cases the leftsided SVC persists with the physiologic right-sided SVC but Hagans et al. report a duplicate superior vena cava with interrupted inferior vena cava in a single patient. The diagnosis of these abnormality is important for the differential diagnosis from mediastinal syndrome (tumor, widened mediastinum) and to prevent per-operative incidents. Declaration of conflicting interests