DOI: https://doi.org/10.36347/sjmcr.2026.v14i09.003

Pages: 1953-1956

Congenital anomalies of systemic venous return result from complex variations in the persistence and regression of the embryonic venous system. Persistent left superior vena cava (PLSVC) is the most common congenital thoracic venous anomaly, whereas the isolated form with absence of the right superior vena cava (RSVC) is rare. Its association with interrupted inferior vena cava (IVC) and hemiazygos continuation is even less common. We report the case of a 52-year-old woman with diabetes and hypertension who was investigated for chronic exertional dyspnea. Contrast-enhanced chest CT demonstrated a single PLSVC draining into a dilated coronary sinus, absence of the RSVC, and an arteria lusoria, with suspected interruption of the IVC. Complementary thoracoabdominal CT angiography confirmed IVC interruption, persistence of a short retrohepatic IVC segment draining into the right atrium, drainage of the hepatic veins into this residual caval segment, and continuation through a dilated hemiazygos vein joining the PLSVC. This configuration creates an unusual pathway for lower systemic venous return through the hemiazygos system, the PLSVC, and the coronary sinus. This case emphasizes the value of multiplanar and maximum-intensity-projection reconstructions for accurate mapping of complex caval anomalies before endovascular, electrophysiologic, or surgical procedures.