A 12 year old presented with history of shortness of breath.
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Both pulmonary veins are draining directly into a vertical vein via a common chamber, and ultimately draining into SVC.
Anomalous drainage of pulmonary veins is seen, with right and left pulmonary veins draining into a common chamber, draining into the vertical vein, joining the innominate vein, and ultimately draining into a dilated superior vena cava.
As it is a supracardiac Total Anomalous Pulmonary Venous connection, a large atrial septal defect can be seen for draining into left atrium. No direct connection between pulmonary veins and left atrium is seen.
Diagnosis was confirmed intra-operatively, however surgery was abandoned due to the inherent risk of ligating the markedly dilated innominate vein.