Total Anomalous Pulmonary Venous Return with connection to the Supradiaphragmatic Inferior Vena Cava: Assessment and Diagnosis by Multidetector Computed Tomography.

Abstract

ig. 1. The frontal chest radiograph showing the anomalous vascular tructure coursing to the right cardiophrenic angle (“scimitar sign”). 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. Anomalous pulmonary venous returns (APVRs) are rare and complex congenital malformations that lead to left-to-right blood shunt and pulmonary hypertension [1–5]. When diagnosed in adults they manifest with respiratory insufficiency and recurrent pulmonary infections. Chest radiograph may be indicative of the