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

Case contributed by Dr Piyush P Siwach

Presentation

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

Patient Data

Age: 70 years
Gender: Male

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.

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

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

Also, bovine arch, a commonly seen variant.

 

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.

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Case information

rID: 79597
Published: 30th Jun 2020
Last edited: 2nd Jul 2020
System: Chest, Cardiac
Inclusion in quiz mode: Included
Excluded from licensing
Institution: Capital Radiology