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Right Upper Lobe Partial Anomalous Pulmonary Venous Connection

DOI: 10.1155/2014/249896

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Abstract:

Partial anomalous pulmonary venous return (PAPVR) is a left-to-right shunt where one or more, but not all, pulmonary veins drain into a systemic vein or the right atrium. We report a case of a 45-year-old male with PAPVR to superior vena cava which was incidentally discovered during a right lower bilobectomy for lung cancer. 1. Introduction Partial anomalous pulmonary venous connection (PAPVC) is an uncommon congenital anomaly in which one or more pulmonary veins drain into a systemic vein or the right atrium rather than the left atrium. Anomalous right-sided pulmonary veins might drain into the superior vena cava, inferior vena cava, right atrium, azygos vein, portal vein, or hepatic vein. Besides, anomalous left-sided pulmonary veins could drain into the left brachiocephalic vein, coronary sinus, or hemiazygos vein. The PAPVC might occur as an isolated anomaly or might be combined with atrial septal defect (ASD) [1]. The PAPVC to the superior vena cava occurs in about 10–15% of all patients with ASD. We report a case of a 45-year-old male with PAPVC that was incidentally discovered during a right lower bilobectomy for lung cancer. 2. Case Report A 45-year-old male had a persistent cough for two months and his chest X-ray showed a nodule in the right lower lobe. A chest computed tomography revealed a mass (5.8 × 6.6 × 6.3?cm) in the right lower lobe that was attached to the right hilum and around the bronchus. Bronchoscopy showed a lesion at the entrance of the right lower lobe that obstructed 30% of the bronchus and pathological examination of a biopsy revealed adenocarcinoma. Spirometry revealed the following values of FVC: 3.17?L (60%) and FEV1: 2.79?L (77%), while electrocardiography showed normal cardiovascular activity. Clinical examination did not reveal marked abnormalities or evidence of vascular shunt. Surgery was performed through a left posterolateral thoracotomy under one-lung ventilation. An anomalous pulmonary vein was incidentally discovered and the right upper lobe vein drained into the superior vena cava. A right bilobectomy was performed. The right upper lobe with the anomalous variation remained as it was. The patient had an uneventful postoperative course. After the operation, a careful examination and reconstruction of the CT images revealed the anomaly (Figures 1 and 2). Figure 1: Multidetector computed tomography showed a PAPVC from the right upper lobe to the superior vena cava (arrow). Figure 2: Another coronal oblique CT image denoted a PAPVC from the right upper lobe to the superior vena cava (arrow). 3. Discussion Partial

References

[1]  T. C. Demos, H. V. Posniak, K. L. Pierce, M. C. Olson, and M. Muscato, “Venous Anomalies of the Thorax,” American Journal of Roentgenology, vol. 182, no. 5, pp. 1139–1150, 2004.
[2]  H. Boody, “Drainage of the pulmonary veins into the right side of the heart,” Archives of Pathology, vol. 33, pp. 221–240, 1942.
[3]  M. D. Black, F. M. Shamji, W. Goldstein, and H. J. Sachs, “Pulmonary resection and contralateral anomalous venous drainage: a lethal combination,” Annals of Thoracic Surgery, vol. 53, no. 4, pp. 689–691, 1992.
[4]  H. Sakurai, H. Kondo, A. Sekiguchi et al., “Left pneumonectomy for lung cancer after correction of contralateral partial anomalous pulmonary venous return,” Annals of Thoracic Surgery, vol. 79, no. 5, pp. 1778–1780, 2005.
[5]  T. Schertler, S. Wildermuth, N. Teodorovic, D. Mayer, B. Marincek, and T. Boehm, “Visualization of congenital thoracic vascular anomalies using multi-detector row computed tomography and two- and three-dimensional post-processing,” European Journal of Radiology, vol. 61, no. 1, pp. 97–119, 2007.
[6]  J. B. Selby, T. Poghosyan, and M. Wharton, “Asymptomatic partial anomalous pulmonary venous return masquerading as pulmonary vein occlusion following radiofrequency ablation,” The International Journal of Cardiovascular Imaging, vol. 22, no. 5, pp. 719–722, 2006.
[7]  A. Shahriari, M. D. Rodefeld, M. W. Turrentine, and J. W. Brown, “Caval division technique for sinus venosus atrial septal defect with partial anomalous pulmonary venous connection,” Annals of Thoracic Surgery, vol. 81, no. 1, pp. 224–230, 2006.
[8]  M. Gupta, “Partial anomalous pulmonary venous connection,” Emedicine, 2010.
[9]  J. R. Dillman, S. G. Yarram, and R. J. Hernandez, “Imaging of pulmonary venous developmental anomalies,” American Journal of Roentgenology, vol. 192, no. 5, pp. 1272–1285, 2009.
[10]  C. J. Zylak, W. R. Eyler, D. L. Spizarny, and C. H. Stone, “Developmental lung anomalies in the adult: radiologic-pathologic correlation,” Radiographics, vol. 22, pp. S25–S43, 2002.
[11]  S. Kivist?, H. H?nninen, and M. Holmstr?m, “Partial anomalous pulmonary venous return and atrial septal defect in adult patients detected with 128-slice multidetector computed tomography,” Journal of Cardiothoracic Surgery, vol. 6, no. 1, article 126, 2011.
[12]  H. Kasahara, R. Aeba, Y. Tanami, and R. Yozu, “Multislice computed tomography is useful for evaluating partial anomalous pulmonary venous connection,” Journal of Cardiothoracic Surgery, vol. 5, no. 1, article 40, 2010.
[13]  W. T. Roberts, J. J. Bax, and L. C. Davies, “Cardiac CT and CT coronary angiography: technology and application,” Heart, vol. 94, no. 6, pp. 781–792, 2008.
[14]  P. Cronin, A. M. Kelly, B. H. Gross et al., “Reliability of MDCT in characterizing pulmonary venous drainage, diameter and distance to first bifurcation. An interobserver study,” Academic Radiology, vol. 14, no. 4, pp. 437–444, 2007.
[15]  H. Takei, K. Suzuki, H. Asamura, H. Kondo, and R. Tsuchiya, “Successful pulmonary resection of lung cancer in a patient with partial anomalous pulmonary venous connection: report of a case,” Surgery Today, vol. 32, no. 10, pp. 899–901, 2002.
[16]  C. Van Meter Jr., J. G. LeBlanc, W. S. Culpepper III, and J. L. Ochsner, “Partial anomalous pulmonary venous return,” Circulation, vol. 82, no. 5, pp. V-195–V-198, 1990.
[17]  J. D. Babb, T. J. McGlynn, W. S. Pierce, and P. M. Kirkman, “Isolated partial anomalous venous connection: a congenital defect with late and serious complications,” Annals of Thoracic Surgery, vol. 31, no. 6, pp. 540–543, 1981.
[18]  H. E. Warden, R. A. Gustafson, T. J. Tarnay, and W. A. Neal, “An alternative method for repair of partial anomalous pulmonary venous connection to the superior vena cava,” Annals of Thoracic Surgery, vol. 38, no. 6, pp. 601–605, 1984.

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