Presentation
Shortness of breath, rule out pulmonary embolism.
Patient Data
No pulmonary embolism. The left upper lobe veins drain into an anomalous vessel to the left of the aortic arch which in turn drains into the left brachiocephalic vein. The anomalous vessel does not connect to the hemi-azygos vein. This is a case of partial anomalous pulmonary venous return.
Case Discussion
If you see a vessel to the left of the aortic arch, there are 3 main possible explanations. If the vessel drains inferiorly into the coronary sinus, the patient has a left superior vena cava. If the vessel has connections to both the left brachiocephalic vein and the hemi-azygos vein, the vessel is a left superior intercostal vein. If the vessel arises from left upper lobe pulmonary veins and drains into the left brachiocephalic vein but does not connect to the hemi-azygos vein, the patient has partial anomalous pulmonary venous return.