Coronary computed tomography angiography findings of anomalous left hepatic vein drainage into the coronary sinus with complex anomalies: a case report.

Background: Drainage of the left hepatic vein into the coronary sinus is an extremely rare anomaly reported in the literature. Typically, haemodynamics remain unimpaired in the absence of concomitant anomalies, and detection is expected to be incidental. Case summary: We herein report a case of a 7-year-old male patient presenting with atypical chest pain, exertional dyspnoea, and mild congestive hepatomegaly, in whom a left hepatic vein draining into a dilated coronary sinus was detected. This anomaly was associated with a superior-inferior type sinus venosus atrial septal defect, persistent left superior vena cava, and partial anomalous pulmonary venous return. Together, these defects created a significant left-to-right shunt, explaining the patient's symptomatic right ventricular strain. Discussion: This case underscores the diagnostic necessity of computed tomography angiography in evaluating complex venous anatomy and its clinical implications. Our findings demonstrate that when echocardiography fails to fully explain right-sided volume overload and atypical symptoms, advanced cross-sectional imaging is decisive for a comprehensive anatomical diagnosis and multidisciplinary surgical planning.