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An enlarged right hilum in a 47-year-old female patient was incidentally found on a chest radiograph (Figure, A) during a health check-up. Subsequent CT angiography (Movies 1 and 2) was performed to differentiate the hilar mass, revealing an anomalously dilated and tortuous single pulmonary venous trunk draining into the left atrium (Figure, B). Without any venous drainage on the left side of the left atrium, the left pulmonary venous trunk (Figure, C) extended tortuously to the right, draining the right branch pulmonary veins, and ultimately entered the left atrium via a single orifice (Figure, B and D). No other cardiovascular structural anomalies were detected, and the echocardiogram showed no significant hemodynamic abnormalities. Thus, the patient remained asymptomatic. This case is an extreme form of a meandering pulmonary vein, which generally refers to the anomalous drainage of the branch pulmonary veins (1). This cardiac abnormality differs from cardiac total anomalous pulmonary venous return and scimitar syndrome return, which both manifest with hemodynamic disturbances and other malformations (2).
A 47-year-old female patient with an anomalous single pulmonary venous trunk. (A) Chest radiograph shows an enlarged right hilum. (B) Frontal, (C) posterior, and (D) coronal three-dimensional volume-rendered reconstructions of CT angiographic images reveal that the enlarged right hilum is attributed to anomalous dilatation and tortuous course of the pulmonary vein trunk. LA = left atrium, LAA = left atrial appendage, LIPV = left inferior pulmonary vein, LPVT = left pulmonary vein trunk, LSPV = left superior pulmonary vein, RIPV = right inferior pulmonary vein, RMPV = right middle pulmonary vein, RSPV = right superior pulmonary vein, SPVT = single pulmonary venous trunk.
Movie 1:
360° spin of routine three-dimensional volume-rendered reconstruction images.
Movie 2:
360° spin of advanced three-dimensional volume-rendered reconstruction images. Red represents the left ventricle to the aorta, purple represents the trachea, dark blue represents the inferior vena cava the right atrium, light blue represents the right ventricular outflow tract-pulmonary artery, and yellow represents pulmonary veins to the left atrium.
Footnotes
Supported by the China Postdoctoral Science Foundation (grant no. 2021M703373).
Disclosures of conflicts of interest: Z.Y. No relevant relationships. X.H. No relevant relationships. G.C. No relevant relationships.
Keywords: Meandering Pulmonary Vein, Pulmonary Veins, CT Angiography, Vasculature
References
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