Abstract
IntroductionWe present a case of dual drainage of the right upper lobe of the lung into the left atrium and via partial anomalous venous pulmonary return (PAPVR) into a persistent left superior vena cava (SVC).DiscussionIt is only in the minority of PAPVR cases where the anomalous pulmonary veins cross the midline. We provide a review of current literature on this topic and an explanatory embryological model. Knowledge of embryonic development and possible anatomic variations, including the concept of dual venous drainage of the lung, leads to better interpretation of imaging, with more accurate description of the morphology at hand. High-resolution multidetector computed tomography (MDCT) helps to delineate the exact vascular anatomy. This will enhance a better understanding of and anticipation on the patient’s disease status, with more accurate planning of intervention, and possibly less complications.
Highlights
We present a case of dual drainage of the right upper lobe of the lung into the left atrium and via partial anomalous venous pulmonary return (PAPVR) into a persistent left superior vena cava (SVC)
There is a broad spectrum of variants and anomalies known, ranging from supernumeraries and abnormal diameter of veins to variants in drainage to the left atrium
During fetal development of the venous pole, three distinct circulatory systems drain, directly or indirectly, on a collective vessel known as the sinus venous, before entering the heart (Fig. 2A): (1) the somatic circulation of the embryo proper, consisting of the right and left anterior and posterior cardinal veins that drain on the common cardinal veins (CCV); (2) the right and left umbilical veins that return oxygenated blood from the placenta; (3) the vitelline circulation that gives rise to the splanchnic plexus, which drains the internal organs, including the developing lungs by means of the right and left pulmonary veins
Summary
Midline crossing pulmonary vein: right upper lobe dual venous drainage, with partial anomalous venous return of the right lung into a persistent left superior vena cava.
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