case_images: PMC5448245_01
case_images: Transthoracic echocardiogram demonstrating rapid presence of agitated saline bubbles in the left ventricle (arrows), suggesting intracardiac right to left shunt. RV: Right ventricle, LV: Left ventricle, RA: Right arm, LA: Left arm
case_images: HV-18-15-g001.jpg
case_images: PMC5448245_01_HV-18-15-g001.jpg
case_images: F1
case_images: Transesophageal echocardiogram demonstrating rapid presence of agitated saline bubbles in left upper pulmonary vein. LA: Left arm, LUPV: Left upper pulmonary vein
case_images: HV-18-15-g002.jpg
case_images: PMC5448245_01_HV-18-15-g002.jpg
case_images: F2
case_images: These findings strongly suggested anomalous venous circulation of the thoracic vessels [Figure 2].
case_images: Computed tomography angiogram demonstrating anomalous connection between the left upper pulmonary vein and the left subclavian vein (arrow). SVC: Superior vena cava, AAo: Ascending aorta
case_images: HV-18-15-g003.jpg
case_images: PMC5448245_01_HV-18-15-g003.jpg
case_images: F3
case_images: Cardiac computed tomography demonstrated a structure parallel to the aorta, coursing from the left upper pulmonary vein (LUPV) toward the left subclavian vein, suggesting either a left-sided superior vena cava (SVC) or less likely a partial anomalous pulmonary vein [Figure 3].
case_images: Static magnetic resonance phase contrast imaging demonstrating black (cephalad) flow in the accessory structure lateral to the descending aorta (arrow). SVC: Superior vena cava, AAo: Ascending aorta, DAo: Descending aorta
case_images: HV-18-15-g004.jpg
case_images: PMC5448245_01_HV-18-15-g004.jpg
case_images: F4
case_images: Subsequent cardiac magnetic resonance with phase contrast cardiac imaging was then performed which demonstrated cephalad blood flow within structure [Figure 4].