Pulmonary veins
The pulmonary veins drain oxygenated blood from the lungs to the left atrium. A small amount of blood is also drained from the lungs by the bronchial veins
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Gross anatomy
There are typically four pulmonary veins, two draining each lung:
- right superior: drains the right upper and middle lobes
- right inferior: drains the right lower lobe
- left superior: drains the left upper lobe
- left inferior: drains the left lower lobe
The pulmonary veins course in the intersegmental septa and as such do not run with the bronchi like the pulmonary arteries do.
The superior pulmonary veins take an oblique inferomedial course whereas the inferior pulmonary veins run horizontally peripherally before taking a more vertical course. They pass through the lung hilum, antero-inferiorly to the pulmonary arteries, forming a short intrapericardial segment, to drain into the left atrium. The ostia of the inferior pulmonary veins are more posteromedial and the left pulmonary veins being more superior.
There is extensive communication with deep bronchial veins within the lung and with the superficial bronchial veins at the hilum.
The pulmonary veins are covered by a short (~9 mm) myocardial layer, which is often the electrical focus of atrial fibrillation with the left superior pulmonary vein being the foci for almost half of cases. These abnormal foci can be treated with RFA.
Variant anatomy
Typical anatomy described above is found in ~70% of patients 1-4. Variant configurations are more common on the right and include:
- common trunks
- common draining trunk of left superior and inferior pulmonary veins
- accessory (additional pulmonary veins)
- single accessory right middle pulmonary vein (~10%)
- two accessory right middle pulmonary veins
- one accessory right middle pulmonary vein and one accessory right upper pulmonary vein
- superior segment right lower lobe vein
- basilar segment right lower lobe vein
- right top pulmonary vein (drains mostly posterior segment of right upper lobe and subsegmental areas of the superior segment of right lower lobe 6)
There may also be partial anomalous pulmonary venous return (PAPVR) where the pulmonary veins drain into a structure besides the left atrium and rarely total anomalous pulmonary venous return (TAPVR) occurs where there is no drainage of pulmonary veins into the left atrium.
Related pathology
Related Radiopaedia articles
Anatomy: Thoracic
- thoracic skeleton
- thoracic cage
- thoracic spine
- articulations
- muscles of the thorax
- diaphragm
- intercostal space
- intercostal muscles
- variant anatomy
- spaces of the thorax
- thoracic viscera
- tracheobronchial tree
-
lungs
-
bronchopulmonary segmental anatomy (Boyden Classification) (mnemonic)
- left lung
- right lung
- variant anatomy
- lung parenchyma
- hilum
- pleura
-
bronchopulmonary segmental anatomy (Boyden Classification) (mnemonic)
-
heart
- cardiac chambers
- heart valves
- pectinate muscles
- cardiac fibrous skeleton
-
coronary arteries
- coronary arterial dominance
- myocardial segments
-
left main coronary artery (LMCA)
- ramus intermedius artery (RI)
-
circumflex artery (LCx)
- obtuse marginal branches (OM1, OM2, etc))
- Kugel's artery
-
left anterior descending artery (LAD)
- diagonal branches (D1, D2, etc)
- septal perforators (S1, S2, etc)
-
right coronary artery (RCA)
- conus artery
- sinoatrial nodal artery
- acute marginal branches (AM1, AM2, etc)
- inferior interventricular artery (PDA)
- posterior left ventricular artery (PLV)
- congenital anomalies
- innervation of the heart
- fetal circulation
- atrial septum
- endocardium
- myocardium
-
pericardium
- epicardium
- epicardial fat pad
- pericardial space
- oblique pericardial sinus
- transverse pericardial sinus
-
pericardial recesses
- aortic recesses
- pulmonic recesses
- postcaval recess
- pulmonary venous recesses
- pericardial ligaments
- esophagus
- thymus
- breast
- blood supply of the thorax
- arteries
- veins
- superior vena cava (SVC)
- inferior vena cava (IVC)
-
coronary veins
- cardiac veins which drain into the coronary sinus
- great cardiac vein
- middle cardiac vein
- small cardiac vein
- posterior vein of the left ventricle
- vein of Marshall (oblique vein of the left atrium)
- anterior cardiac veins
- venae cordis minimae (smallest cardiac veins or thebesian veins)
- cardiac veins which drain into the coronary sinus
- pulmonary veins
- thoracoepigastric vein
- lymphatics
- innervation of the thorax