Partial anomalous pulmonary venous return (PAPVR)

Case contributed by Dr Arkadi Tadevosyan

Presentation

Patient admitted to emergency department with shortness of breath and retrosternal chest pain.

Patient Data

Age: 30
Gender: Male
CT

ECG Gated CTA

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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Case information

rID: 61333
Published: 28th Jun 2018
Last edited: 2nd Jun 2019
System: Chest, Cardiac
Inclusion in quiz mode: Included
Institution: "AMC" Yerevan

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