Oblique vein of the left atrium – The Marshall vein

Abstract

\A 36-year-old woman with a medical history of partial anomalous pulmonary venous return (PAPVR) presented to our Emergency Department with chest pain and left arm numbness. The patient's vital signs, physical exam, ECG, chest radiograph, and laboratory work-up (including serum troponin levels) were all normal. Further evaluation with gated cardiac CT angiography (Fig. 1) demonstrated the patient's known PAPVR (not shown) as well as an incidentally noted small vessel originating from the left atrium (LA) and communicating with the coronary sinus (CS, curved blue arrow) at its junction with the great cardiac vein (GCV, yellow arrow), consistent with an oblique vein of the left atrium (a.k.a., Marshall vein; MV, white arrow). The Marshallvein is a rare fetal remnant of the left superior vena cava, persisting as a left atrial tributary that empties into the great cardiac vein at its junction with the coronary sinus. 1,2 This vessel lies within Marshall's ligament, a fold of pericardium containing fibromuscular bands and neurovascular tissue. 1,2 Marshall's liga