PDF(Pubmed)
Abstract：
UNASSIGNED: Congenital thoracic venous anomalies (CTVAs) with right-to-left shunt constitute an uncommon source of paradoxical embolization in adults. We present a case of a healthy and physically fit individual with a rare asymptomatic anomaly first presenting with brain abscesses after a visit to the dental office; persistent left superior vena cavae (PLSVC) without bridging vein, over-riding right-sided superior vena cavae (RSVC) connected to the left atrium (LA), and an extracardiac sinus venosus defect.
UNASSIGNED: A 29-year-old male presented to the neurosurgical unit due to intracranial abscesses requiring intervention following a visit to his dentist. The abscess cultures isolated bacteria commonly found in the normal oral flora. Transthoracic echocardiography revealed an enlarged coronary sinus consistent with PLSVC. An agitated saline study was performed and raised suspicion of simultaneous extra- and intracardiac shunting. Magnetic resonance angiography confirmed the presence of a PLSVC and revealed an RSVC connected to the LA; however, no intracardiac shunt was evident. Electrocardiogram-gated computed tomography was therefore conducted and discovered the rudimentary remains of the physiologic RSVC forming a connection to the right atrium, explaining the bilateral contrast loading seen on the agitated saline study and diagnosing an extracardiac sinus venosus defect (SVD). The patient recovered and has been referred for surgery.
UNASSIGNED: This case illustrates a CTVA and a forme fruste type SVD resulting in a severe complication in a healthy adult. We highlight the diagnostic challenges posed, suggest early usage of agitated saline studies, and discuss the rationale for surgical correction of this patient.
UNASSIGNED: A 29-year-old male presented to the neurosurgical unit due to intracranial abscesses requiring intervention following a visit to his dentist. The abscess cultures isolated bacteria commonly found in the normal oral flora. Transthoracic echocardiography revealed an enlarged coronary sinus consistent with PLSVC. An agitated saline study was performed and raised suspicion of simultaneous extra- and intracardiac shunting. Magnetic resonance angiography confirmed the presence of a PLSVC and revealed an RSVC connected to the LA; however, no intracardiac shunt was evident. Electrocardiogram-gated computed tomography was therefore conducted and discovered the rudimentary remains of the physiologic RSVC forming a connection to the right atrium, explaining the bilateral contrast loading seen on the agitated saline study and diagnosing an extracardiac sinus venosus defect (SVD). The patient recovered and has been referred for surgery.
UNASSIGNED: This case illustrates a CTVA and a forme fruste type SVD resulting in a severe complication in a healthy adult. We highlight the diagnostic challenges posed, suggest early usage of agitated saline studies, and discuss the rationale for surgical correction of this patient.
摘要：
未经证实：先天性胸静脉异常（CTVA）伴右向左分流是成人反常栓塞的罕见来源。我们介绍了一个健康且身体健康的个体，其罕见的无症状异常在访问牙科诊所后首次出现脑脓肿；持续的左上腔静脉（PLSVC）没有桥接静脉，与左心房（LA）相连的右侧上腔静脉（RSVC），还有心外窦静脉缺损.
未经证实：一名29岁男性因颅内脓肿就诊于神经外科病房，在看牙医后需要介入治疗。脓肿培养物分离了正常口腔菌群中常见的细菌。经胸超声心动图显示冠状窦增大，符合PLSVC。进行了激动的盐水研究，并怀疑同时进行心外和心内分流。磁共振血管造影证实存在PLSVC，并显示RSVC连接到LA；然而，没有明显的心内分流。因此，进行了心电图门控计算机断层扫描，发现了与右心房形成连接的生理性RSVC的基本残留物，解释在激动盐水研究中看到的双侧对比剂负荷，并诊断心外窦静脉缺损（SVD）。患者康复，已转诊接受手术。
UNASSIGNED：该病例说明了CTVA和形式截头型SVD导致健康成人严重并发症。我们强调了所带来的诊断挑战，建议早期使用搅动盐水研究，并讨论手术矫正该患者的理由。
未经证实：一名29岁男性因颅内脓肿就诊于神经外科病房，在看牙医后需要介入治疗。脓肿培养物分离了正常口腔菌群中常见的细菌。经胸超声心动图显示冠状窦增大，符合PLSVC。进行了激动的盐水研究，并怀疑同时进行心外和心内分流。磁共振血管造影证实存在PLSVC，并显示RSVC连接到LA；然而，没有明显的心内分流。因此，进行了心电图门控计算机断层扫描，发现了与右心房形成连接的生理性RSVC的基本残留物，解释在激动盐水研究中看到的双侧对比剂负荷，并诊断心外窦静脉缺损（SVD）。患者康复，已转诊接受手术。
UNASSIGNED：该病例说明了CTVA和形式截头型SVD导致健康成人严重并发症。我们强调了所带来的诊断挑战，建议早期使用搅动盐水研究，并讨论手术矫正该患者的理由。
