Anomalous pulmonary venous drainage of the left upper lobe shown by CT scans

Isolated anomalous drainage of the left superior pulmonary vein into the left brachiocephalic vein was shown on computed tomographic (CT) scans. The CT findings include a vertical vein lateral to the aorticopulmonary window and aortic arch that terminates in the left brachiocephalic vein. Features that differentiate this entity from left superior vena cava, anomalous left brachiocephalic vein, and superior intercostal vein are discussed.     

Partial anomalous pulmonary venous return

Partial anomalous pulmonary venous return (PAPVR) is an uncommon congenital abnormality that occurs in 0.4 to 0.7% of postmortem examinations. Ninety percent of these anomalies are associated with an atrial septal defect. Partial anomalous pulmonary venous return occurs more commonly on the right than the left and is manifested by abnormal return of the pulmonary veins to the central venous circulation. Most patients are asymptomatic, but when symptoms are present they are due to shunting of oxygenated blood to the venous circulation. We submit the case of a recently activated solider who presented with dyspnea on exertion refractory to inhaled corticosteroids and an 8.5-mm solitary pulmonary nodule. Further diagnostic imaging revealed PAPVR. Our case appears to be the first report of a solitary pulmonary nodule as the initial presentation of a right upper lobe PAPVR with return to the superior vena cava in the absence of associated atrial septal defect.     

64层螺旋CT血管成像对儿童肺静脉异位引流的诊断价值

目的：研究64层螺旋CT血管成像（MSCTA）在儿童肺静脉异位引流（APVD）中的应用价值。方法：回顾性分析18例APVD患者的MSCTA资料,常规行多平面重组（MPR）、薄层最大密度投影（MIP）和容积再现（VR）等后处理,并与经胸超声心动图（TE）进行对照研究。结果：所有患儿MSCTA均显示肺静脉回流异常,17例完整显示引流静脉行径,17例患儿引流位置诊断明确,显示率均高于TE。重组图像能直观明确的显示引流静脉的整体形态。结论：MSCTA结合后处理技术对APVD诊断价值高于TE,能全面的评价患儿状况并指导治疗。     

Partial anomalous pulmonary venous return in Turner syndrome

PurposeThe aim of this study is to describe the prevalence, anatomy, associations and clinical impact of partial anomalous pulmonary venous return in patients with Turner syndrome.Methods and resultsAll Turner patients who presented at our Turner clinic, between January 2007 and October 2015 were included in this study and underwent ECG, echocardiography and advanced imaging such as cardiac magnetic resonance or computed tomography as part of their regular clinical workup. All imaging was re-evaluated and detailed anatomy was described. Partial anomalous pulmonary venous return was diagnosed in 24 (25%) out of 96 Turner patients included and 14 (58%) of these 24 partial anomalous pulmonary venous return had not been reported previously. Right atrial or ventricular dilatation was present in 11 (46%) of 24 partial anomalous pulmonary venous return patients.ConclusionWhen studied with advanced imaging modalities and looked for with specific attention, PAPVR is found in 1 out of 4 Turner patients. Half of these patients had right atrial and/or ventricular dilatation. Evaluation of pulmonary venous return should be included in the standard protocol in all Turner patients.     

Computed tomography diagnosis of partial anomalous pulmonary venous drainage

A case of the rarely occurring partial anomalous pulmonary venous drainage of the right upper lobe into the azygos arch is presented. Computed tomography (CT) clearly demonstrated the abnormal vessel coursing through the right upper lobe and draining into the azygos arch.     

部分型肺静脉异位引流1例

患者女,70岁。因阵发性房颤入院。查体：心界略大,各瓣膜区未闻及明显病理性杂音。超声检查：轻度肺动脉高压伴中度三尖瓣反流;轻度二尖瓣反流;主动脉瓣钙化伴轻度主动脉瓣反流。左房肺静脉CT成像：左房大小正常。左房及左心耳未见充盈缺损。左下肺静脉及右上、下肺静脉走行正常,汇人左房（图1）。左上肺静脉未进入左房,由左上纵隔旁垂直静脉引流入左头臂静脉,汇入上腔静脉（图2～4）。CT诊断：部分型肺静脉异位引流（心上型）。     

A case of an anomalous pulmonary vein of the right middle lobe

A case is reported in which the abnormal course of a pulmonary vein was suggested by computed tomography and confirmed by digital subtraction angiography. The vein drained blood from the right middle lobe into the apical pulmonary vein. This abnormality was probably due to abnormal segmentation of the right lung. Comparable cases have been reported in the literature. It is important to distinguish these benign lesions from more complex malformations because of the therapeutic and prognostic implications. The radiologic findings of this case and a systematic overview of pulmonary vein abnormalities is provided.     

MR diagnosis of subdiaphragmatic anomalous pulmonary venous drainage in a newborn

Our report describes a case of infradiaphragmatic total anomalous pulmonary venous return diagnosed by MR in a newborn with an interruption of the aortic arch with ventricular septum defect and anomalous pulmonary venous drainage. The severity of the congenital cardiopathy did not permit surgical treatment and the infant died soon after. Pathology confirmed the MR findings. Magnetic resonance not only complements echocardiography but also can be used for patients in intensive care and can in our case avoid angiography.     

混合型完全性肺静脉异位引流的CT及MRI诊断

目的探讨CT及MRI对混合型完全性肺静脉异位引流的诊断价值。方法以手术证实为混合型完全性肺静脉异位引流的26例患儿为研究对象,回顾性分析其CT及MRI影像。结果 26例患儿的CT及MRI影像均清晰显示肺静脉异位引流的途径,诊断的正确率为100%。26例混合型完全性肺静脉异位引流可分为两类,①"3+1"型:3支肺静脉回流入右心房或冠状静脉窦或体循环静脉,而另1支肺静脉则回流入另一侧的体循环静脉,此类共22例;②"2+2"型:指两侧的肺静脉分别回流入不同的位置,此类共2例。另有2例异位引流的肺静脉超过4支。结论 CT及MRI能够准确地诊断混合型完全性肺静脉异位引流。     

完全性肺静脉畸形引流心内型一例

患者女,19岁。自幼发现心脏杂音,生长发育较同龄人略迟缓,活动后胸闷、心慌、气短,无晕厥、喜蹲踞现象,紫绀( )。血压96/60mmHg心率61次/min。心界向两侧扩大,律不齐,可闻及早搏、大炮音;胸骨左缘第二、三肋间4/6级收缩期杂音,传导广泛,并可触及震颤,周围血管征阴性。     

Intrahepatic arterioportal shunting and anomalous venous drainage: understanding the CT features in the liver

The increased use of high-contrast volume, arterial-phase studies of the liver has demonstrated the frequent occurrence of arterioportal shunts within both the cirrhotic and non-cirrhotic liver. This article sets out to explain the underlying microcirculatory mechanisms behind these commonly encountered altered perfusion states. Similarly, well-recognised portal perfusion defects occur around the perifalciform and perihilar liver and are largely caused by anomalous venous drainage via the paraumbilical and parabiliary venous systems. The underlying anatomy will be discussed and illustrated. These vascular anomalies are all caused by or result in diminished portal perfusion and are often manifest in the setting of portal venous thrombosis. The evolving concept of zonal re-perfusion following portal vein thrombosis will be discussed.