A 71-year-old man presented with drowsiness three hours before admission. Stroke or hepatic encephalopathy was suspected but computed tomography (CT) scan of the brain revealed no abnormality. Cardiac auscultation discovered pansystolic murmurs at apex radiated to axilla. Plain chest roentgenogram showed markedly cardiac enlargement and electrocardiogram (ECG) revealed atrial fibrillation. Transthoracic echocardiography was performed to detect the etiology of cardiac enlargement, but it discovered a dilated coronary sinus instead. Finally, a very rare case of persistent left superior vena cava (PLSVC) with absence of right superior vena cava (RSVC) anomaly that is also known as isolated PVSVC was incidentally demonstrated by transesophageal echocardiography. The patient also had severe mitral and tricuspid regurgitations. Diabetes mellitus, dyslipidemia, and suspected cirrhosis of liver were also found. He was treated for hepatic encephalopathy, which is not related to PLSVC and he recovered uneventfully. PLSVC should be expected if any intracardiac venous procedures are going to be performed such as central venous catheterization, device implantation, or coronary artery bypass surgery.

Keywords: Persistent left superior vena cava, Congenital venous anomaly, Dilated coronary sinus, Echocardiography

Received 30 Sep 2019 | Revised 22 Oct 2019 | Accepted 24 Oct 2019