Anomalous pulmonary venous drainage: a pictorial essay with a CT focus

Abstract

The imaging of pulmonary venous anatomy has traditionally been performed with echocardiography and catheter pulmonary angiography. Magnetic resonance imaging (MRI) and notably multi-detector row computed tomography (CT) have refined the usual imaging techniques. Anomalous pulmonary venous drainage (APVD) is the drainage of one or more pulmonary veins outside the left atrium. Its detection is critical due to the strong association with congenital heart disease as well as other cardiac and respiratory anomalies, which have significant implications for patient management. The pervasive application of CT combined with the relatively non-specific clinical presentation of APVD has resulted in the increased incidental detection of these anomalies. Knowledge is hence vital as the imaging specialist is now usually the first person to make such a diagnosis. Furthermore, pulmonary veins are an important site for arrhythmogenic foci and radiofrequency ablation of such sites is used in the treatment of refractory atrial fibrillation. Hence an imaging road map of these veins is crucial before any management can take place. This pictorial review will illustrate embryology, normal and variant pulmonary vein anatomy, and varied patterns of APVD. Finally, we discuss the implications in the treatment of atrial fibrillation.

Persistent left superior vena cava: clinical importance and differential diagnoses

“…However, PLSVC may have a direct connection with the left pulmonary veins. In this scenario, the pulmonary vein drains into the left atrium after joining PLSVC [12,28].…”

“…In the case of APVD, the LBCV and RSVC may be of large caliber because the VV transports blood via these venous structures. On the other hand, PLSVC, frequently, is associated with an absent or small-sized LBCV [12,28].…”

“…Nevertheless, the frequency of this probability is very low for LACV compared to PLSVC. Additionally, they may be seen together, and the LACV may drain into PLSVC [28,30].…”

Left partial anomalous pulmonary venous connection (PAPVC), a rare pulmonary venous variant

“…The left upper pulmonary vein is seen laterally to the aorta and anteriorly to the left main bronchus. This anomalous venous connection can be mistaken for a double superior vena cava but in this case only one vein is seen at the level of the left hilum [2] .…”

“…The overall incidence is estimated between 0,4 and 0,7%. The right side is more commonly affected, whereas the left side is affected up to 18,2% [2 , 7] .…”