Fehlmündende Lungenvene als Zufallsbefund

Abstract

A partial anomalous pulmonary venous connection (PAPVC) is a congenital abnormality of the great thoracic vessels the incidence of which is underestimated and is associated with a left-right shunt. It rarely develops into a right-sided cardiac insufficiency. Because of the mostly low left-right shunt volume, a PAPVC is often asymptomatic and mostly incidentally detected in advanced age. Incorrect positioning of a central venous catheter or paradoxical blood gas parameters can serve to indicate the presence of a PAPVC. This article presents the case a 50-year-old patient with a PAPVC of the left upper lobe pulmonary vein draining into the left innominate vein without prior clinical symptoms. Blood gas analyses from the superior vena cava, where the catheter placement was confirmed by computed tomography angiography, showed unexplainable arterial values. The anatomical abnormality was confirmed by computed tomography.

Unknown Partial Anomalous Pulmonary Venous Connection Causing Arterial Blood Gases During Central Venous Catheter Insertion

“…Nevertheless, clinical case reports mostly report about PAPVC of the left pulmonary veins (PV) [12]. Anomalous connections in 12 patients were located in the left upper PV in 9 patients, the right upper PV in 2 patients and both upper PV in one patient [9,12]. Only 2 of the 12 patients suffered from symptoms (dyspnea, right heart insufficiency) and underwent surgery.…”

“…In 5 of the 12 patients, an abnormal position of a central venous catheter was seen. In all of them the CVC was inserted via the left jugular vein [12].…”

Central Venous Line Insertion Revealing Partial Anomalous Pulmonary Venous Return: Diagnosis and Management

“…In addition, PO 2 was reported to be high in four other cases, but no arterial sample was obtained to compare [13–16]. The high PO 2 can be explained by the fact that the catheter tip is collecting blood directly from the pulmonary venous blood flow before intermixing with systemic venous blood [15]. The fourth step would be to confirm placement via definitive radiologic method.…”