Incidental noninvasive diagnosis of isolated persistent left superior vena cava in asymptomatic adults: A case report.

IPLSVC is an extremely rare congenital malformation with a low overall prevalence in the general population and a relatively high rate of missed diagnoses.

• Most patients present without typical clinical manifestations, contributing to frequent missed diagnoses in clinical practice.
• The condition involves abnormal venous drainage and is frequently complicated with lesions of the cardiac conduction system, which may induce arrhythmias.
• The rarity and asymptomatic nature of IPLSVC make it difficult to detect without incidental imaging.

A 37-year-old asymptomatic male patient was incidentally found to have IPLSVC during a routine physical examination using chest echocardiography and CT scans.

• The patient had no history of cyanosis, breathing difficulties, chest pain, or family history of heart disease.
• Transthoracic echocardiography revealed coronary sinus dilatation, a key imaging finding prompting further investigation.
• Chest CT confirmed the absence of the right superior vena cava and the confluence of the right innominate vein into the left superior vena cava.
• The diagnosis of IPLSVC was established by combining imaging findings with clinical manifestations.

Noninvasive echocardiography provided the basis for early diagnosis of IPLSVC in an asymptomatic patient and demonstrated clinical significance as a screening tool.

• Transthoracic echocardiography identified coronary sinus dilatation, which served as the initial diagnostic clue.
• Complete echocardiography and chest CT together confirmed the diagnosis without invasive procedures.
• The authors concluded that noninvasive echocardiography 'can provide a basis for early diagnosis of asymptomatic patients and has certain clinical significance.'
• Routine cardiac ultrasound was confirmed to have screening value for detecting IPLSVC.

IPLSVC increases the risk of complications during central venous access, cardiothoracic surgery, and pacemaker implantation even in asymptomatic patients.

• The authors noted that 'although IPLSVC patients are often asymptomatic in the early stages, it may increase the risk of central venous access, cardiothoracic surgery, and pacemaker implantation.'
• The patient was informed of relevant procedural risks following diagnosis.
• Regular follow-up examinations and ambulatory electrocardiogram monitoring were recommended to the patient.
• The patient experienced no discomfort during follow-up, and long-term cardiac monitoring was advised.

Regular reexamination and long-term cardiac monitoring were recommended as the management strategy for this asymptomatic IPLSVC patient.

• No intervention was performed; clinical management consisted of patient education, risk counseling, and surveillance.
• Ambulatory electrocardiogram monitoring was specifically recommended given the known association between IPLSVC and cardiac conduction system lesions.
• Imaging data were retained for use in subsequent diagnosis and treatment.
• The case provides 'practical references for the diagnosis, follow-up, and clinical management of similar cases.'