Use of CT angiography in the diagnosis of total anomalous venous return

Abstract

Total anomalous pulmonary venous return (TAPVR) is an uncommon cause of cyanotic congenital heart disease in the neonatal period. This diagnosis is often made by echocardiography. We present two cases where echocardiography was not confirmatory. Computerized tomography (CT) scan of the chest and abdomen with contrast was performed instead of cardiac catheterization to establish the diagnosis. We suggest that CT with contrast is a noninvasive modality to obtain anatomic details of pulmonary venous drainage in TAPVR when echocardiography is inconclusive.

Portal Venous Gas: A Clinical Finding in Obstructed Infracardiac Total Anomalous Pulmonary Venous Connection

“…Although echocardiograms are highly sensitive and specific in diagnosing TAPVC, in the present case, the complete diagnosis was not made with the initial echocardiogram but was delayed until after the CT study [2,3]. Even a postmortem review of the echocardiogram by a pediatric cardiologist still failed to make the complete diagnosis despite identifying the four pulmonary veins.…”

Computed tomography features of supracardiac total anomalous pulmonary venous connection in an infant

“…[1] The incidence of this rare entity is approximately 1 of 17,000 live births [2] or 1%-5% of all cardiovascular congenital anomalies [3].…”

“…TAPVC is a cause of neonatal cyanosis, and if right-to-left shunt is not present, it may rapidly result in death [3]; hence, being a surgical emergency in neonates [2].…”

“…In severe cases, urgent diagnosis and surgical correction is essential to reduce morbidity and mortality [2]. However, if there is no obstruction and a sufficient shunt is present, patients may not present to clinic urgently [7].…”

“…CT angiography is then a noninvasive and sensitive choice for mapping the PVs without need for invasive cardiac catheterization [2], [9].…”