Case 74: Right-sided superior vena cava draining into left atrium in a patient with persistent left-sided superior vena cava

A 61-year-old man with hypogammaglobulinemia presented with recent onset of shortness of breath and pleuritic chest pain. He was slightly cyanotic. Results of an examination of the chest and cardiovascular system were unremarkable. There was no history of cardiac disease. A chest radiograph showed a few small areas of peripheral airspace opacity. Perfusion lung scintigraphy was performed to assist in the evaluation of pulmonary embolism after injection of technetium 99m (Tc) macroaggregated albumin (MAA) into a right arm vein. Given the findings of this examination, contrast material–enhanced computed tomography (CT) of the chest was performed on the same day. A 100-mL dose of iopamidol 300 was injected into a right arm vein at a rate of 4 mL/sec, and image acquisition commenced 20 seconds after the start of the injection. Another episode of pleuritic chest pain prompted another perfusion examination 19 days later. This time, Tc-MAA was injected into a left arm vein.