Total anomalous pulmonary venous return with connection to the supradiaphragmatic inferior vena cava: assessment and diagnosis by multidetector computed tomography.

摘要

A49 year-old woman with a history of chronic dyspnoea and respiratory insufficiency was referred to our department for imaging. The patient had been previously treated for three episodes of fever and pulmonary infection, occurred within the last year. A chest radiograph had shown a slight reduction of size of the right hemithorax and moderate prominence of the right cardiac edge (Fig. 1). A curvilinear image paralleling the right heart border and extending with the inferior portion below the diaphragmatic shape had also been reported ("scimitar sign"). Contrast-enhanced multidetector-row computed tomography (MDCT) was performed (Fig. 2a and b). The MDCT examination confirmed the dilatation of right heart chambers and the increased size of the pulmonary arteries. An anomalous pulmonary vein return draining the entire right lung into the inferior vena cava was also demonstrated. The normal main pulmonary veins of the right lung connecting to the left atrium were not shown (total return). The supradiaphragmatic vena cava was enlarged and showed early filling with contrast medium. The diagnosis of total anomalous pulmonary venous return was made and the patient was referred to surgical evaluation.