MDCT of Partial Anomalous Pulmonary Venous Return (PAPVR) in Adults

Abstract

The purpose of this study was to determine the lobar distribution and associated radiologic/clinical findings of partial anomalous pulmonary venous return (PAPVR) in the adult population using multidetector computed tomography (MDCT). The radiology information database was queried for patients with PAPVR diagnosed on chest computed tomography. Forty-seven cases of PAPVR were retrospectively identified from 45,538 contrast-enhanced chest computed tomography examinations performed over an 8-year period. Diagnostic findings were confirmed via consensus review by 2 cardiothoracic radiologists. Medical charts were evaluated for ancillary radiographic data, cardiopulmonary signs and symptoms, and subsequent surgical interventions. Calculated disease prevalence was 0.1%, with mean patient age of 58 years and a 58% female predominance. PAPVR was observed with 47% frequency in the left upper lobe, 38% right upper lobe (RUL), 13% right lower lobe, and 2% left lower lobe. Among cases of RUL PAPVR, 42% were associated with sinus venosus atrial septal defect (ASD). Other reported anomalies were right-sided volume overload (47%), isolated upper lobe PAPVR (29% left and 5% right), bilateral PAPVR (4%), scimitar syndrome (13%), persistent left superior vena cava (9%), and azygos continuation of the inferior vena cava (4%). Reported cardiopulmonary signs/symptoms and imaging modalities other than MDCT were neither sensitive nor specific for PAPVR. Surgical repair was performed in 21% of cases and included ASD patching, intracardiac baffle, anomalous vein anastomosis, systemic vein translocation, and Warden procedure. This represents the largest and only consecutive retrospective study of PAPVR in adults to date. Left upper lobe PAPVR was the most frequent location detected on MDCT, whereas RUL PAPVR was slightly less common and moderately associated with sinus venosus ASD. Utilization of contrast-enhanced studies and MDCT technology has enabled improved detection and characterization of PAPVR for early diagnosis and/or intervention.