Presentation
Cardiac MR imaging workup for cardiac device revealed likely pulmonary anomalies. CT pulmonary venogram was then performed for better anatomical visualization.
Patient Data
Partial anomalous venous drainage of the left upper lobe via left superior pulmonary venous drainage into the left superior intercostal vein and then into the left brachiocephalic vein. The left inferior pulmonary vein drains into the left atrium. Normal three-vessel aortic arch configuration.
Some hypodense cystic lesions in liver segment 6 are likely simple hepatic cysts.
Case Discussion
Partial anomalous pulmonary venous return (PAPVR) is a congenital cardiovascular condition in which some pulmonary veins (but not all) drain into the systemic circulation rather than into the left atrium 1. Previous cardiac MR imaging (unable to be obtained) performed as part of a workup for cardiac device insertion revealed likely pulmonary abnormalities. The patient had a background history of dilated cardiomyopathy; any symptoms caused by PAPVR could easily be attributed to their pre-existing cardiac condition.
Suspicion of PAPVR can sometimes be deduced on x-ray imaging alone, particularly on the right side (scimitar syndrome).
PAPVR is an important consideration when inserting a central venous catheter. When performed under image guidance, the tip of the catheter may move away from the expected location of the cavo-atrial junction.
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