Imaging of Pulmonary Venous Developmental Anomalies

Abstract

There are numerous developmental pulmonary venous anomalies. Although these conditions have traditionally been evaluated with echocardiography and angiography, they can be accurately diagnosed using both MRI and MDCT.

Report of a rare anatomic variant: left upper lobe partial anomalous pulmonary venous return

“…Partial anomalous pulmonary venous return (PAPVR) is a rare condition with a prevalence of 0.4-0.7% (1). In PAPVR, up to three pulmonary ventricular septal defect or a patent ductus arteriosus (1).…”

Congenital Thoracic Venous Anomalies in Adults: Morphologic MR Imaging

“…Blackblood images (typically acquired with single-shot fast spin echo with double inversion recovery or half-Fourier single-shot turbo spin echo sequences) are useful to study the anatomy of the heart and mediastinum; cine bright-blood images (usually obtained using a 2-dimentional (2D) or 3D balanced steady-state free precession sequence) allow the assessment of the cardiac chambers and valvular function. 3,4 Angiographic techniques include 3D T1-weighted contrastenhanced MRA, time of flight MRA, and phase contrast MRA, the latter 2 providing angiographic information in patients in whom intravenous administration of gadolinium is contraindicated. Gadolinium-enhanced MRA (non-electrocardiogram-gated 3D spoiled gradient recalled echo imaging technique) is extremely valuable in the assessment of the thoracic vascular structures, allowing dynamic imaging during the arterial and venous phases, of both the systemic and pulmonary circulation.…”

“…Phase contrast MRA, also called velocity-encoded sequence, evaluates flow direction and velocity, allowing the quantification of shunts. [2][3][4] Our standard protocol for evaluating thoracic venous anomalies consists of axial, sagittal, and coronal half-Fourier single-shot turbo spin echo sequences, steady-state free precession sequences to evaluate ventricular function, and 3D contrast-enhanced MRA. Contrast-enhanced MRA image is obtained after intravenous injection of a double dose (0.20 mmol/kg of body weight) of gadolinium-containing contrast media, at an injection rate of 2 mL/s; the acquisition is initiated manually using care bolus tracking technique.…”

“…The shunt is thought to become clinically significant when 50% or more of the pulmonary blood flow returns anomalously. 4 The incidental detection of PAPVR requires detailed anatomical description of the anomaly, namely in patients undergoing lobectomy for a pulmonary neoplasm. When the anomalous vessel is located in a lobe other than the one affected by the neoplasm, some authors suggest that the PAPVR should be corrected during lobectomy to prevent right-sided heart failure caused by increased blood flow through the aberrant vein.…”

Haemoptysis due to pulmonary venous stenosis

“…The embryological formation of the pulmonary veins is quite complex and there is a remarkable diversity of pulmonary vein connections into the left atrium [71][72][73][74]. The classical description of two left-sided (left superior (LSPV) and left inferior (LIPV)) and two right-sided (right superior (RSPV) and right inferior (RIPV)) separately ending pulmonary veins accounts for only ,70% of the normal population.…”