A 44-year-old fit and active female was referred by her general practitioner with palpitations, mostly occurring at rest. Electrocardiography performed in the community demonstrated sudden onset of an atrial tachycardia of 115 beats per min. When assessed in hospital, she was asymptomatic with a blood pressure of 110/62 and a regular pulse rate of 50 beats per min. Resting electrocardiography revealed sinus rhythm with poor R wave progression with no evidence of left ventricular hypertrophy or ischemia. A 24-h electrocardiography demonstrated four beats of atrial tachycardia.\nA transthoracic echocardiogram demonstrated a prominent coronary sinus, moderate mitral regurgitation, and a bicuspid aortic valve []. Transesophageal echocardiography showed normal biventricular systolic function, left atrial dilatation, mild to moderate mitral regurgitation, and tricuspid regurgitation. The aortic valve was bicuspid with trivial aortic regurgitation but no significant stenosis. The ascending aorta was dilated for her age and body surface area, with a maximum diameter of 4.0 cm. There was no evidence of aortic coarctation or dissection.\nSaline contrast echocardiography was performed via the left and right arms [], [], [] and []. This confirmed PLSVC with no obvious shunt. Cardiac magnetic resonance imaging (MRI) demonstrated bicuspid aortic valve with dilated aortic root. A PLSVC was seen draining into the coronary sinus and then the right atrium. A separate right-sided non-hypoplastic superior vena cava also emptied into the right atrium. It was noted that a left-sided IVC drained into the coronary sinus and right atrium. Three hepatic veins were seen emptying into a short right-sided IVC, again draining into the right atrium.
A 46-year-old lady underwent CT chest abdomen and pelvis for breast cancer staging. The CT was reported as free of secondary pathology; however, the below-discussed findings were observed.\nThe CT scan shows the infrarenal tract of the IVC localised on the left side of the aorta. This left paramedian IVC is of normal calibre and crosses the middle line at the level of the celiac trunk, behind the aorta (). At T 12, the IVC continues its way up to the chest as Azygos vein, passing through the aortic hiatus of the diaphragm. No embryologic remnants of the supracardinal veins are noted on the right side of the aorta. A large vein is located ventromedially to the ureter on both sides, consistent with large ovarian veins. Furthermore, the right renal vein follows an anomalous course, as it is situated posteriorly to the aorta to drain into the left-sided IVC. Finally, a partial duplication of the left ureter is noted ().