A persistent left superior vena cava is most readily identified on which ultrasound view?

• A. Three-vessel/trachea view
• B. Four-chamber view
• C. Parasternal long-axis view
• D. Ductal view

Answer: (A)

Identifying abnormal venous return patterns in the great vessels is the key idea here. The persistent left superior vena cava is best seen in the three-vessel/trachea view because this transverse plane directly shows the major venous and arterial connections to the heart—the aorta, main pulmonary artery, and the superior vena cava. In this view, an extra left-sided venous channel that runs toward the heart and drains into the coronary sinus becomes apparent, making the left SVC easier to detect than in other views. A dilated coronary sinus on a subsequent four-chamber view can support the finding, but the three-vessel/trachea view is the most straightforward and reliable for identifying the left SVC. The four-chamber view mainly assesses atrial and ventricular chambers and septa, so it’s less optimal for visualizing the left-sided venous return. The parasternal long-axis and ductal views focus on ventricular outflow and ductal anatomy, not the venous return pattern, making them less suitable for this purpose.