September 18, 2010

Partial Anomalous Pulmonary Venous Return (PAPVR)

Figures 1-3: Contiguous axial contrast-enhanced CT images show an abnormal left upper lobe pulmonary vein draining into the left vertical vein (arrows) that subsequently empties into the left brachiocephalic vein (BCV).

Facts: PAPVR
  • Common venous anomalies of the thorax (0.5% prevalence in general population)
  • Pulmonary-to-systemic, left-to-right shunt
  • Anomalous pulmonary vein drains into the right sided circulation (SVC, azygos, brachiocephalic, IVC, coronary sinus, right atrium)
  • Symptomatic if large or associated with other cardiopulmonary anomalies
  • Most common form = right upper lobe vein draining into SVC, left upper lobe vein draining into left vertical vein
  • Surgical correction recommended if pulmonary-to-systemic flow ratio greater than 1.5 to avoid progression to pulmonary hypertension and right ventricular failure
Martinez-Jimenez S, Heyneman LE, McAdams HP, et al. Nonsurgical extracardiac vascular shunts in the thorax: clinical and imaging characteristics. Radiographics 2010; 30,e41-.

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