대한흉부영상의학회 Korean Society of Thoracic Radiology

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대한흉부영상의학회 Weekly Case 검색
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Weekly Chest CasesArchive of Old Cases

Case No : 410 Date 2005-09-05

  • Courtesy of Hyun Jin Park, MD, Seong Hee Park, MD. / Department of Diagnostic Radiology, Kangnam St. Mary's Hospital, Seoul, Korea
  • Age/Sex 78 / M
  • Chief ComplaintIncidental abnormality on CT
  • Figure 1
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Diagnosis With Brief Discussion

Diagnosis
Partial Anomalous Pulmonary Venous Return
Radiologic Findings
Contrast enhanced CT scans and volume rendering 3D image show left superior pulmonary vein enters left brachiocephalic vein along the lateral aspect of the aortic arch. Left inferior pulmonary vein is normally drained into left atrium.
Brief Review
Anomalous pulmonary vein drainage involves drainage of a pulmonary vein branch into the right atrium, coronary sinus, or systemic vein, producing a left-to-right shunt.

Patients are most frequently asymptomatic. The extent of symptoms and physiologic disturbances are dependent on the degree of shunting, the number of anomalous veins, any associated valvular abnormalities, and the presence of any concomitant cardiac or pulmonary disease. Surgical correction is recommended for symptomatic patients or asymptomatic patients with a pulmonary-to-systemic blood flow ratio exceeding 1.5 because of their higher likelihood of progression to pulmonary hypertension and right ventricular failure.

Partial Anamalous pulmonary vein drainage is present in about 0.5% of the population. The anomalous vein may drain into various vascular structures. On the right, the most common are the superior vena cava, azygos vein, inferior vena cava, and right atrium. On the left, drainage may be through the left brachiocephalic vein, persistant left superior vena cava, or coronary sinus. Drainage may be also below the diaphragm. In the scimitar syndrome, the aberrant drainage of the right pulmonary vein occurs the below the diaphragm, often into the inferior vena cava.

Total anomalous pulmonary venous drainage must be associated with a septal defect and is best considered to be a type of congenital heart disease.
References
1. Webb WR. Congenital bronchopulmonary lesions In. Webb WR, Higgins CB. Thoracic imaging, Philadelphia: LWW, 2005 1-29

2. Naidich DP, M?ler NL, et al. Pulmonary arteries and hilar In. Computed tomography and magnetic resonance of the thorax. 1999 603-656

3. AboulHosn JA, Crilev JM, Stringer WW. Partial anomalous pulmonary venous return: case report and review of the literature.
Catheter Cardiovasc Interv. 2003 Apr;58(4):548-52.
Keywords
Vascular, Vascular,

No. of Applicants : 36

▶ Correct Answer : 25/36,  69.4%
  • - New Hyde Park, New York, USA Pinar Karakas
  • - Kangnam St. Mary's Hospital, Seoul, Korea Jun-Young Chung
  • - Dong-Eui Medical Center, Busan, Korea Hoon Sik Jung
  • - IRCCS S.Luca Hospital, Milano, Italy Filippo Casolo
  • - Regional Hospital Taguatinga, Brasilia, Brazil Fabricio Goncalves
  • - Ondokuz Mayis University, Samsun, Turkey Cetin Celenk
  • - Monaldi Hospital, Naples, Italy Gaetano Rea
  • - Ev. Krkhs. Hubertus, Berlin, Germany Michael Weber
  • - Kyung Hee University Hospital, Seoul, Korea Jeong Hwa Kong
  • - Kosin university gospel hospital, Busan, Korea Mi Hee Jung
  • - Max Hospital, New Delhi, India Anurag Jain
  • - ASL Bologna, Maggiore Hospital, Bologna, Italy Marcellino Burzi
  • - Hospital of the Unversity of Pennsylvania, USA Lisa Jones
  • - Yonsei University Hospital, Korea Eun Hye Yoo
  • - Ping Tung Christian Hospital,Taiwan Jun-Jun Yeh
  • - Radiologie Guiton, La Rochelle, France Denis Chabassiere
  • - Maimonides Medical Center, Brooklyn, New York, USA Naomi Twersky
  • - Cabinet de Radiologie Guiton, La Rochelle, France Jean-Luc Bigot
  • - Daejon St Mary's Hospital, Korea ChaeHun Lim
  • - Incheon Sarang Hospital, Incheon, Korea Jung Hee Kim
  • - SSGH, Vadodara Medical College, Gujarat, India Sushil Mansingani
  • - Annemasse, Polyclinique de Savoie, France Gay-Depassier
  • - Homs National Hospital, Homs, Syria Rami Abou Zalaf
  • - Shiga University of Medical Science, Shiga, Japan Yukihiro Nagatani
  • - Social Security Hospital, Ankara, Turkey Meric Tuzun
▶ Semi-Correct Answer : 1/36,  2.8%
  • - Yonsei University Hospital, Korea Hyun Suk Choi
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