Presentation
Abnormal ECG with incomplete right bundle branch block. Abnormal echocardiography with suspect of an anomalous pulmonary venous return.
Patient Data
The images show a drain of the superior right pulmonary vein into the systemic circulation true the VCS. Bilateral subsegmental/round lung atelectasis.
In the axial True FISP sequences, there is also visible a sinus venosus atrial septal defect ( in addition to the drain of the right superior pulmonary vein into the VCS).
The MRA shows the superior right pulmonary vein that drain into the systemic circulation true the VCS. The CINE 4C shows also a pericardial effusion.
The MRI- cardiac flow analysis also shows a severe left-to-right shunt as a result of the partial anomalous pulmonary venous return and the interatrial defect.
Case Discussion
Partial anomalous pulmonary venous connection (PAPVC) is a rare congenital cardiac defect. As the name suggests, in PAPVC, the blood flow from a few of the pulmonary veins return to the right atrium instead of the left atrium. Usually, a single pulmonary vein is anomalous. Rarely, all the veins from one lung are anomalous. Thus, some of the pulmonary venous flow enters the systemic venous circulation.
MRI provides noninvasive volumetric anatomic data and enables evaluation of systemic veins, as well as the number, origin, course, and drainage of all pulmonary veins, including anomalous connections or obstruction. MRI also quantifies ventricular volumes and evaluates the right ventricular outflow tract and pulmonary trunk, sites of stenosis, pulmonary artery conduits or branch pulmonary arteries.
In this case, MRI of partial anomalous pulmonary venous return quantifies any shunt, patency, and ventricular systolic function.
Although pulmonary venous developmental anomalies have been evaluated traditionally with echocardiography and angiography, MRI is playing an increasing role in their characterization.
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