Presentation
Patient admitted to emergency department with shortness of breath and retrosternal chest pain.
Patient Data
Left superior pulmonary vein drains into brachiocephalic(innominate) vein, creating a left to right shunt(consistent with supracardial type PAPVR). Right heart is enlarged. Single accessory right middle pulmonary vein is noted. Some fibrotic changes predominantly in posterior segments of both lung.
Tubular outpouching arising from the apex of left ventricle consistent with ventricular diverticulum (incidental finding).
Case Discussion
Left-sided PAPVR has been reported to be found more often in adults, whereas right-sided PAPVR is reported more commonly in children. It is unclear if this is because of a higher proportion of symptomatic manifestation of the latter. The left upper lobe vein anomaly is thought to be most common.
Subtypes of a left ventricular diverticulum:
- muscular type
- often originates at the apex and comprises mainly muscular fibers that contract synchronously with the ventricle(which was in our case)
- often associated with other congenital defects
- fibrous diverticulum: composed of mostly fibrous tissue.
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