Bridged Bilateral Superior Venae Cavae With Direct Left Atrial Appendage Connection and No Other Congenital Cardiac Anomaly

A persistent left superior vena cava (SVC) results from failed obliteration of the left common cardinal vein during embryogenesis, with a spectrum of anatomic variants. We report a rare case of bilateral SVCs connected by a bridging vein and with a direct left SVC connection to the left atrial appendage in an asymptomatic patient without hypoxemia or associated congenital heart disease on transthoracic echocardiography, computed tomography, and magnetic resonance imaging. A multimodality imaging approach is valuable to search for associated anomalies and to confirm this anatomic variant, which has important implications on vascular procedures and avoidance of systemic embolism.