Pulmonary veins

Changed by Raymond Chieng, 16 Aug 2023
Disclosures - updated 17 Aug 2022: Nothing to disclose

Updates to Article Attributes

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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.

Gross anatomy

There are typically four pulmonary veins, two draining each lung:

The pulmonary veins course in the intersegmental septa and as such do not run with the bronchi like the pulmonary arteries do 7.

TheAs the pulmonary veins are draining into the left atrium, the superior pulmonary veins take an oblique inferomedial course whereasare located anteroinferior to the right pulmonary arteries while the inferior pulmonary veins run horizontally peripherally before taking a more vertical course. They pass through the lung hilum, antero-inferiorlywhen compared to the vertical course taken by pulmonary arteries, forming a short intrapericardial segment, to drain into the left atrium1,7. The ostia of the inferior pulmonary veins are more posteromedial than the superior pulmonary veins and the ostia of left pulmonary veins being more superior than right pulmonary veins 1.

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 isolated with radiofrequency ablation.

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 other than 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

  • -</ul><p>The pulmonary veins course in the intersegmental septa and as such do not run with the bronchi like the pulmonary arteries do <sup>7</sup>.</p><p>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 <a href="/articles/lung-hilum">hilum</a>, 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. </p><p>There is extensive communication with deep <a href="/articles/bronchial-veins">bronchial veins</a> within the lung and with the superficial bronchial veins at the hilum.</p><p>The pulmonary veins are covered by a short (~9 mm) myocardial layer, which is often the electrical focus of <a href="/articles/atrial-fibrillation">atrial fibrillation</a> with the left superior pulmonary vein being the foci for almost half of cases. These abnormal foci can be isolated with radiofrequency ablation.</p><h4>Variant anatomy</h4><p>Typical anatomy described above is found in ~70% of patients <sup>1-4</sup>. Variant configurations are more common on the right and include:</p><ul>
  • +</ul><p>The pulmonary veins course in the intersegmental septa and as such do not run with the bronchi like the pulmonary arteries do <sup>7</sup>.</p><p>As the pulmonary veins are draining into the left atrium, the superior pulmonary veins are located anteroinferior to the right pulmonary arteries while the inferior pulmonary veins run horizontally when compared to the vertical course taken by pulmonary arteries <sup>1,7</sup>. The ostia of the inferior pulmonary veins are more posteromedial than the superior pulmonary veins and the ostia of left pulmonary veins being more superior than right pulmonary veins <sup>1</sup>.</p><p>There is extensive communication with deep <a href="/articles/bronchial-veins">bronchial veins</a> within the lung and with the superficial bronchial veins at the hilum.</p><p>The pulmonary veins are covered by a short (~9 mm) myocardial layer, which is often the electrical focus of <a href="/articles/atrial-fibrillation">atrial fibrillation</a> with the left superior pulmonary vein being the foci for almost half of cases. These abnormal foci can be isolated with radiofrequency ablation.</p><h4>Variant anatomy</h4><p>Typical anatomy described above is found in ~70% of patients <sup>1-4</sup>. Variant configurations are more common on the right and include:</p><ul>

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