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

Reference

Martinez-Jimenez S, Heyneman LE, McAdams HP, et al. Nonsurgical extracardiac vascular shunts in the thorax: clinical and imaging characteristics. Radiographics 2010; 30,e41-.