Image challenge 2


A 19-year-old lady was admitted to our cath lab for complete diagnostic catheterization. She had a clinical history of syncope and tachycardia at rest.

The EKG showed sinus rhythm with incomplete right bundle branch block. At transthoracic echocardiogram the left ventricle was normal, while the right ventricle was dilated (32 cm2) with normal function (TAPSE 23 mm); mild tricuspid regurgitation and pulmonary artery dilation (29 mm) were present. Left to right shunt (Qp/Qs >2) was detected. Thus, partial anomalous pulmonary venous drainage was suspected. Interestingly, the coronary sinus appeared dilated. The patient could not undergo nuclear magnetic resonance due to claustrophobia.

This is an image recorded during invasive diagnostic catheterization.

What is the most likely diagnosis?

Degenerated venous graft
Atrial septal defect
Persistent left superior vena cava draining into coronary sinus
Diffuse superior vena cava thrombosis
Accessory hemiazygos vein
Occluded left carotid artery with flow reversal
{"name":"Image challenge 2", "url":"https://www.quiz-maker.com/QVNLTWP","txt":"A 19-year-old lady was admitted to our cath lab for complete diagnostic catheterization. She had a clinical history of syncope and tachycardia at rest. The EKG showed sinus rhythm with incomplete right bundle branch block. At transthoracic echocardiogram the left ventricle was normal, while the right ventricle was dilated (32 cm2) with normal function (TAPSE 23 mm); mild tricuspid regurgitation and pulmonary artery dilation (29 mm) were present. Left to right shunt (Qp\/Qs >2) was detected. Thus, partial anomalous pulmonary venous drainage was suspected. Interestingly, the coronary sinus appeared dilated. The patient could not undergo nuclear magnetic resonance due to claustrophobia. This is an image recorded during invasive diagnostic catheterization. What is the most likely diagnosis?","img":"https://www.quiz-maker.com/3012/images/ogquiz.png"}
Powered by: Quiz Maker