PLSVC - Incidental-oma

Don't forget to take any home monitoring reports/ECGs (from Kardia, Apple Watch) etc to your appointment

by Gemita - 2024-06-29 12:59:18

Andie, Thank you for explaining about persistent left superior vena cava.  It would appear that this condition can be a relatively benign finding and you seem to be symptom free at the moment which is a good sign.  However you clearly need to be careful before any invasive surgical procedures and you have clearly already experienced technical difficulties with the condition during placement of your pacemaker leads.

With regard to the “incidentaloma”, I attach a .pdf for those interested.  You don’t actually say anything about this in your post or its connection with the persistent left superior vena cava, if there is one?

With regard to questions for your cardiologist, if you are symptom free I wouldn’t necessarily trouble him with any questions about these conditions, unless they are not well managed and you have any concerns?   If you are having symptoms which you believe could be related to these conditions, then I would ask about the need for further investigations or a treatment plan?  I hope you have kept diary notes of any symptoms, dates, duration of events to take with you to your appointment, so that they can check symptoms against your monitoring reports.  I would tend to go with only one or two important questions and cover these thoroughly rather than present with too many questions.  

Are you asking for general pacing questions to ask your cardiologist, or only questions relating specifically to the two conditions you mention here??  

https://www.ese-hormones.org/media/0eyj3qqr/ese-patient-leaflet_adrenal-incidentaloma_final.pdf

Thanks and Correction...

by Andiek11 - 2024-06-29 17:12:34

Gemita, appreciate your input and perspective as always.  Specifically I was seeking to know if there are any questions I should ask the cardilologist about the PLSVC.  From what I've read so far, if I'd had some type of related condition I would have know of this years / decades ago because of symptoms.  What is not quite so clear is what issues might develop in the future because of this extra bit of plumbing.  So there is where I'm trying to focus.  Honestly by the time you reach your last 60's if there haven't been any issues so far, hopefully that means that none will develop, but better to ask than to not. 

I also apoloigize fo any confusion with my use of the term "indicentaloma."  At least here in the states it is a very borad term used to describe any "suprise" findings seen on tests / imaging studies that was unrelated to what the test was actually looking for.  I have no issues with my adrenals that I am remotely aware of (thank heaveans).  

Happy Saturday to all - 

Incidental findings

by Gemita - 2024-06-29 19:38:04

Andie, I had a good chuckle!  I am sorry about the misunderstanding, the misinterpretation. I am glad that you do not have adrenal problems.  

I see that the clinical significance of PLSVC depends on the drainage site and any accompanying cardiac abnormalities. PLSVC without cardiac abnormalities is generally asymptomatic and detected as an incidental finding. 

In the case of PLSVC with right atrial drainage, I see that the coronary sinus can expand and that any undue enlargement may cause compression of the atrioventricular node and His bundle, which "could" lead to cardiac arrhythmias like atrial/ventricular fibrillation.  Compression of the left atrium and decreased cardiac output may occur due to this enlargement although the PLSVC usually drains into the right atrium through the dilated coronary sinus with no hemodynamic consequences.  

Sometimes the PLSVC drains into the left atrium causing right to left shunt, but this is usually not large enough to cause cyanosis since it only drains the left upper limb and left side of the head and neck. 

You could ask whether your condition could lead to pacing difficulties or arrhythmias in the future?

You could ask whether you have any cardiac abnormalities like ventricular or atrioventricular septal defects which can be associated with PLSVC?

You could ask how frequently asymptomatic PLSVC should be monitored to see whether other cardiac abnormalities develop?

Arrhythmias and conduction abnormalities appear common in the presence of PLSVC due to a dilated coronary sinus which will stretch the AV nodal tissue predisposing to reentrant tachycardia, so I would focus on this area.  Note:  PLSVC carries coronary sinus blood retrograde (backwards) into the left innominate vein, and in most cases it drains into the right atrium through the coronary sinus in the absence of congenital heart disease.  

I hope by asking questions and by learning about the PLSVC it will not cause undue concern,  particularly if you are largely symptom free and have no other significant cardiac abnormalities or any significant structural or functional problems?   Knowing about the PLSVC can only be helpful to keep a watchful eye on things.  Hope your appointment gives reassurance 

In UK medicine it used to be call a 'fascinoma'

by crustyg - 2024-06-30 06:41:03

From the patient's perspective, the most important thing is to stop doctors from unnecessary investigations (which were quite a hazard before MRI), as often the 'little biopsy' or whatever would lead to complications and then it just got worse.

I've seen it in my own family, but happily we managed to stop the enthusiasm for further workups.

Thanks for sharing.

Fascinoma

by piglet22 - 2024-06-30 07:04:22

Well, that's interesting.

At first glance I thought it might be some lump caused by a flesh eating bacteria.

And it's all English!!

by Andiek11 - 2024-06-30 10:39:53

Piglet22 thanks for making ME laugh!  That's a pretty logical thought there...

Crustyg - totally agree, that once something is found too often it leads to an unnecessary barage of tests, some of which are invasive and all of which are expensive - unless you've got a very savvy doctor. However to give the 360 perspective, sometimes accidential findings can be life saving too.  Problem is that it is not often easy to know up front  so the choice is explore or not explore.  *yuck - I hate these types of choices*

Gemita - Glad I was able to make YOU laugh.  Kinda like hitch-hiking in different countries - the hand gesture in one country for flagging down a ride could mean something very, very different (and sometimes even offensive!) in a different country. Ooops!  But this also points out some of the pitfalls when trying to communicate with your health team.  They're sure of what they're hearing and what you mean and you're sure that what you said was totally different.  And one wonders why world peace has not yet been achieved.    ;)