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A 31-year-old female patient presented with chest pain and breathlessness for 2 months. The patient was previously asymptomatic and had no comorbidities. Transesophageal echocardiography showed coronary sinus dilatation, and CT angiography (CTA) was recommended to rule out anomalous pulmonary venous drainage. CTA depicted drainage of the left pulmonary veins into the coronary sinus through a common channel. The right pulmonary veins were observed as draining normally into the left atrium (Figure; Movies 1, 2).
CT angiography (CTA) images in a 31-year-old female patient with a dilated coronary sinus identified at echocardiography. (A) Axial oblique CTA image shows the right superior and inferior pulmonary veins draining normally into the left atrium. The coronary sinus is dilated. The right ventricle is slightly enlarged. (B) Coronal oblique CTA image shows the anomalous drainage of the left superior and inferior pulmonary veins into the coronary sinus through a common channel. There was no defect between the wall of the left atrium and the coronary sinus. (C) Sagittal oblique CTA image shows the common channel coursing posteriorly to the left atrium, to open into the right atrium through the coronary sinus. (D) Virtually reconstructed three-dimensional image (posterior view) shows the common channel formed by the left superior and inferior pulmonary veins opening into the right atrium through the coronary sinus. Ao = aorta, CC = common channel, CS = coronary sinus, LA = left atrium, LIPV = left inferior pulmonary vein, LSPV = left superior pulmonary vein, LV = left ventricle, MPA = main pulmonary artery, RA = right atrium, RIPV = right inferior pulmonary vein, RSPV = right superior pulmonary vein, RV = right ventricle.
Movie 1:
Axial scroll-through imaging clip depicts the anomalous drainage.
Movie 2:
Three-dimensional coronal cinematic rendering depicts the anomalous drainage.
Partial anomalous pulmonary venous return (PAPVR) is an uncommon congenital anomaly with a prevalence of 0.4% to 0.7% (1). It is characterized by drainage of at least one of the pulmonary veins into a compartment other than the left atrium. PAPVR involving the right pulmonary veins is most common, with left-sided PAPVR occurring in only about 10% of total cases (2). Anomalous drainage into the coronary sinus is extremely rare, with only isolated case reports in the literature, and is highlighted in the present case.
Footnotes
Authors declared no funding for this work.
Disclosures of conflicts of interest: P.S. No relevant relationships. S.H.N. No relevant relationships. A.S. No relevant relationships. M.S. No relevant relationships.
Keywords: CT Angiography, Cardiac, Pulmonary Veins, Pulmonary Venous Return, Coronary Sinus
References
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