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