Partial anomalous pulmonary venous return (PAPVR) - entire left lung

Case contributed by Piyush P Siwach
Diagnosis certain

Presentation

Dry Cough, mixed obstructive/restrictive pattern on PFTs. Ex smoker

Patient Data

Age: 70 years
Gender: Male
This study is a stack
Axial C+
arterial phase
This study is a stack
Axial lung
window
This study is a stack
Axial lung
window
Download
Info

There are mild COAD changes in the lungs. No confluent airspace consolidation or any focal suspicious lesion in this smoker.

If you have already made the diagnosis, excellent!! Otherwise please scroll down to thin soft tissue windows.

Download
Info

I thought history was important as the findings are very unusual for patient's age and presentation.

This study is a stack
Coronal C+
arterial phase
This study is a stack
Axial C+
arterial phase
Download
Info

Partial anomalous pulmonary venous return of entire left lung. Please see below for the annotated images.

Also, bovine arch, a commonly seen variant.

 

Download
Info

Pulmonary veins from the left lung carrying oxygenated blood (therefore marked in red) drain into the right atrium via coronary sinus, resulting in a left to right shunt..

Case Discussion

This 70-year-old man has been pumping half of his oxygenated blood back to his right heart for 70 years now. Still, he has remained relatively asymptomatic despite being a smoker—one of the very rare cases of late diagnosis of PAPVR despite such a large shunt.

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

:

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.