A Case of an Anomalous Superior Vena Cava with Anomalous Pulmonary Veins—When Two Wrongs Do not Make a Right

Intravenous agitated saline injection is useful in identifying right‐to‐left shunting at the atrial or intrapulmonary level. Anomalous systemic venous drainage to the left atrium is a rare but easily correctable cause of right‐to‐left shunting which, if left undiagnosed, may have serious consequences, including meningitis and pyogenic brain abscesses. This case illustrates an unusual cause of right‐to‐left shunting and the utility of venous microbubble injection in its diagnosis. (Echocardiography 2011;28:E39‐E41) Intravenous agitated saline injection is useful in identifying right‐to‐left shunting at the atrial or intrapulmonary level. Anomalous systemic venous drainage to the left atrium is a rare but easily correctable cause of right‐to‐left shunting which, if left undiagnosed, may have serious consequences, including meningitis and pyogenic brain abscesses. This case illustrates an unusual cause of right‐to‐left shunting and the utility of venous microbubble injection in its diagnosis.