Simultaneous Occurrence of Partial Anomalous Pulmonary Venous Return and Major Bronchial Anomaly

Abstract

The objective of this study was to describe the computed tomography (CT) findings of 5 adult patients with a combination of partial anomalous pulmonary venous return (PAPVR) and major bronchial anomaly. A computerized search of the radiological database records of 4886 consecutive patients who underwent chest CT from April 2005 to May 2007 described 2 patients with a combination of PAPVR and tracheal bronchus (TB). Three additional patients with a combination of PAPVR and TB or accessory cardiac bronchus (ACB) were obtained by reviewing the CT images of the patients initially diagnosed as having PAPVR, TB, or ACB at our institution during the same period. The CT findings of these 5 patients were analyzed. Four patients had a combination of right PAPVR and right TB, and 1 patient had a combination of left PAPVR and ACB. These combinations were found in 42% (5/12) of patients with PAPVR, 16% (4/25) of patients with TB, and 14% (1/7) of patients with ACB. In 4 patients with a combination of right PAPVR and right TB, the anomalous vein was draining the right upper lobe and draining into either the posterior aspect of the superior vena cava (SVC) or the terminal portion of the azygos arch. The origin of the TB was the trachea in 1 patient and the carina in 2 patients. Two distinct TBs presented in 1 patient; the first TB was from the lower trachea, and the second was from the right main bronchus. The right upper lobe affected by PAPVR included the territory ventilated by the TB in all 4 patients. A combination of right PAPVR draining to the superior vena cava or azygos arch and right TB is most common. The possibility that the PAPVR and a major bronchial anomaly might coexist in 1 patient should be considered whenever either of them is encountered on CT.