{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T07:04:26Z","timestamp":1776755066839,"version":"3.51.2"},"reference-count":16,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,12,19]]},"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:p>A 34-year-old woman was seen in the emergency department for shortness of breath and chest pain. During a pandemic, it is easy to \u2018think horses and not zebras\u2019, and with a patient presenting with the classic coronavirus symptoms it would have been easy to jump to that as her diagnosis. After a careful history and examination, it became clear that there was another underlying diagnosis. Chest X-ray, echocardiogram and CT scan revealed marked right ventricular dilatation and pulmonary hypertension, alongside a persistent left superior vena cava (PLSVC). Further investigation with cardiac MRI and coronary angiography at a tertiary centre demonstrated that she not only have a PLSVC but also a partial anomalous pulmonary venous drainage and sinus venosus atrial septal defect. This case highlights the importance of considering all differentials and approaching investigations in a logical manner.<\/jats:p>","DOI":"10.1136\/bcr-2020-239687","type":"journal-article","created":{"date-parts":[[2021,1,12]],"date-time":"2021-01-12T05:06:05Z","timestamp":1610427965000},"page":"e239687","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Rare case of right ventricular dilatation associated with anomalous pulmonary venous drainage, sinus venosus atrial septal defect and persistent left superior vena cava"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2485-4954","authenticated-orcid":false,"given":"Stephanie","family":"Rees","sequence":"first","affiliation":[{"name":"Acute Medicine, Betsi Cadwaladr University Health Board, Rhyl, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8643-9852","authenticated-orcid":false,"given":"Muhammad","family":"Tahir","sequence":"additional","affiliation":[{"name":"Cardiology, Betsi Cadwaladr University Health Board, Rhyl, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4865-3065","authenticated-orcid":false,"given":"Syed Jawad","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Acute Medicine, Betsi Cadwaladr University Health Board, Rhyl, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0319-8174","authenticated-orcid":false,"given":"Eduardas","family":"Subkovas","sequence":"additional","affiliation":[{"name":"Cardiology, Betsi Cadwaladr University Health Board, Rhyl, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,1,11]]},"reference":[{"key":"2025082703194630000_14.1.e239687.1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2019-315945"},{"key":"2025082703194630000_14.1.e239687.2","first-page":"834","article-title":"The differential diagnosis of dyspnea","volume":"113","author":"Berliner","year":"2016","journal-title":"Dtsch Arztebl Int"},{"key":"2025082703194630000_14.1.e239687.3","first-page":"221","article-title":"Adult congenital heart disease","volume":"4","author":"Moodie","year":"2002","journal-title":"Ochsner J"},{"key":"2025082703194630000_14.1.e239687.4","unstructured":"Atrial Septal Defects - NORD (National Organization for Rare Disorders). Available: https:\/\/rarediseases.org\/rare-diseases\/atrial-septal-defects\/ [Accessed Aug 2020]."},{"key":"2025082703194630000_14.1.e239687.5","doi-asserted-by":"crossref","first-page":"1645","DOI":"10.1056\/NEJM199012133232401","article-title":"Long-Term outcome after surgical repair of isolated atrial septal defect","volume":"323","author":"Murphy","year":"1990","journal-title":"N Engl J Med Overseas Ed"},{"key":"2025082703194630000_14.1.e239687.6","unstructured":"Persistent Left Superior Vena Cava - an overview | ScienceDirect Topics. Available: https:\/\/www.sciencedirect.com\/topics\/medicine-and-dentistry\/persistent-left-superior-vena-cava [Accessed Aug 2020]."},{"key":"2025082703194630000_14.1.e239687.7","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1007\/s00246-017-1778-3","article-title":"Incidence of persistent left superior vena cava in the normal population and in patients with congenital heart diseases detected using echocardiography","volume":"39","author":"Nagasawa","year":"2018","journal-title":"Pediatr Cardiol"},{"key":"2025082703194630000_14.1.e239687.8","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1111\/echo.13447","article-title":"Persistent left superior vena cava accompanying congenital heart disease in children: experience of a tertiary care center","volume":"34","author":"Ari","year":"2017","journal-title":"Echocardiography"},{"key":"2025082703194630000_14.1.e239687.9","unstructured":"Sadler TW . Langman\u2019s Medical Embryology. 12th edn. Philadelphia, PA: Lippincott Williams & Wilkins, 2012: 223\u201375."},{"key":"2025082703194630000_14.1.e239687.10","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.104.493775"},{"key":"2025082703194630000_14.1.e239687.11","doi-asserted-by":"publisher","DOI":"10.1016\/S0009-9260(86)80382-8"},{"key":"2025082703194630000_14.1.e239687.12","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000116753.56467.BC"},{"key":"2025082703194630000_14.1.e239687.13","first-page":"662","article-title":"Hypoxia caused by persistent left superior vena cava connecting to the left atrium a rare clinical entity","volume":"39","author":"Freeman","year":"2012","journal-title":"Tex Heart Inst J"},{"key":"2025082703194630000_14.1.e239687.14","doi-asserted-by":"publisher","DOI":"10.1378\/chest.129.5.1313"},{"key":"2025082703194630000_14.1.e239687.15","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(71)90011-7"},{"key":"2025082703194630000_14.1.e239687.16","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1086\/674302","article-title":"Pericardial effusion in pulmonary arterial hypertension","volume":"3","author":"Sahay","year":"2013","journal-title":"Pulm Circ"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2020-239687","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T10:19:56Z","timestamp":1756289996000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2020-239687"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1]]},"references-count":16,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,1,11]]},"published-print":{"date-parts":[[2021,1]]}},"alternative-id":["10.1136\/bcr-2020-239687"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2020-239687","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1]]}}}