unilateral pulmonary venous atresia is a rare anomaly presenting with recurrent chest infections and hemoptysis . this condition must be considered in the differential diagnosis when children present with recurrent unilateral pneumonia , particularly when associated with hemoptysis and reduced lung volume . a 7-year - old girl was admitted to the hospital for evaluation of recurrent chest infections since the age of 4 months and recurrent hemoptysis for the past 4 years , with about 1 - -2 episodes per year . though there was no definitive evidence of tuberculosis , the child had received two courses of antituberculous treatment on an empirical basis . at admission , chest radiograph revealed a small right hemithorax , with mediastinal shift to the same side and increased opacity throughout the right lung field [ figure 1 ] . chest radiograph shows a small right hemithorax , with increased opacity throughout the right lung and ipsilateral tracheal and mediastinal shift ct scan of the chest and cta showed a small right hemithorax with interlobular septal thickening and increased attenuation throughout the right lung . cta revealed a small right main pulmonary artery , complete absence of the pulmonary veins on the right side , and normal pulmonary veins on the left . a confluent soft tissue mass was seen adjacent to the left atrium [ figure 3 ] . a prominent right bronchial artery supplying the right lung and additional systemic vascular supply from a prominent left inferior phrenic artery were also identified on the angiographic images [ figure 4 ] . note the normal central bronchi axial ( a ) and coronal ( b ) maximum intensity projection ( mip ) ct angiography images depict complete absence of the right - sided pulmonary veins ; there is a smooth left atrial margin ( black arrow ) with an adjacent soft tissue opacity ( thick white arrow ) . a few dot - like enhancing vascular channels , representing bronchial collaterals , are seen on the right side ( arrowhead ) . the small right pulmonary artery is well appreciated on the coronal image ( thin white arrow ) volume - rendered ct angiogram ( posterior view ) shows a prominent right bronchial artery ( arrow ) and a prominent inferior phrenic artery ( long arrow ) . note the absence of the pulmonary veins on the right side echocardiography of the patient revealed a small right pulmonary artery . a 3-year - old girl was referred for bronchoscopy with a history of recurrent hemoptysis since the age of 1 year . the child had a hemoglobin level of 12 g% and her general physical examination was unremarkable . the chest radiograph revealed a small right hemithorax , with evidence of consolidation in the right middle and lower zones [ figure 5 ] . the chest radiograph shows an area of consolidation ( arrow ) in the right mid - zone ct scan of the chest revealed a small right hemithorax with ipsilateral mediastinal shift and multiple areas of consolidation in the lung parenchyma [ figure 6 ] . cta depicted a hypoplastic right main pulmonary artery [ figure 7 ] , with nonvisualization of the pulmonary veins [ figure 8 ] . coronal ct scans ( lung windows ) show areas of consolidation ( arrows ) on the right side with a small hemithorax and normal central airways axial multiplanar reconstruction ct scan shows the small right pulmonary artery ( arrow ) and the normal left pulmonary artery ( thick arrow ) coronal ( a ) and axial ( b ) multiplanar reconstruction ( mpr ) ct scan images show the complete absence of the right pulmonary veins ; the left superior and inferior pulmonary veins ( arrows ) are well seen . the left atrial outline is smooth , and minimal soft tissue ( arrowhead ) is noted adjacent to it volume - rendered aortic angiogram ( posterior view ) shows a prominent right bronchial artery ( arrow ) . a 7-year - old girl was admitted to the hospital for evaluation of recurrent chest infections since the age of 4 months and recurrent hemoptysis for the past 4 years , with about 1 - -2 episodes per year . though there was no definitive evidence of tuberculosis , the child had received two courses of antituberculous treatment on an empirical basis . at admission , chest radiograph revealed a small right hemithorax , with mediastinal shift to the same side and increased opacity throughout the right lung field [ figure 1 ] . chest radiograph shows a small right hemithorax , with increased opacity throughout the right lung and ipsilateral tracheal and mediastinal shift ct scan of the chest and cta showed a small right hemithorax with interlobular septal thickening and increased attenuation throughout the right lung . cta revealed a small right main pulmonary artery , complete absence of the pulmonary veins on the right side , and normal pulmonary veins on the left . a confluent soft tissue mass was seen adjacent to the left atrium [ figure 3 ] . a prominent right bronchial artery supplying the right lung and additional systemic vascular supply from a prominent left inferior phrenic artery were also identified on the angiographic images [ figure 4 ] . note the normal central bronchi axial ( a ) and coronal ( b ) maximum intensity projection ( mip ) ct angiography images depict complete absence of the right - sided pulmonary veins ; there is a smooth left atrial margin ( black arrow ) with an adjacent soft tissue opacity ( thick white arrow ) . a few dot - like enhancing vascular channels , representing bronchial collaterals , are seen on the right side ( arrowhead ) . the small right pulmonary artery is well appreciated on the coronal image ( thin white arrow ) volume - rendered ct angiogram ( posterior view ) shows a prominent right bronchial artery ( arrow ) and a prominent inferior phrenic artery ( long arrow ) . note the absence of the pulmonary veins on the right side echocardiography of the patient revealed a small right pulmonary artery . a 3-year - old girl was referred for bronchoscopy with a history of recurrent hemoptysis since the age of 1 year . the child had a hemoglobin level of 12 g% and her general physical examination was unremarkable . the chest radiograph revealed a small right hemithorax , with evidence of consolidation in the right middle and lower zones [ figure 5 ] . the chest radiograph shows an area of consolidation ( arrow ) in the right mid - zone ct scan of the chest revealed a small right hemithorax with ipsilateral mediastinal shift and multiple areas of consolidation in the lung parenchyma [ figure 6 ] . cta depicted a hypoplastic right main pulmonary artery [ figure 7 ] , with nonvisualization of the pulmonary veins [ figure 8 ] . coronal ct scans ( lung windows ) show areas of consolidation ( arrows ) on the right side with a small hemithorax and normal central airways axial multiplanar reconstruction ct scan shows the small right pulmonary artery ( arrow ) and the normal left pulmonary artery ( thick arrow ) coronal ( a ) and axial ( b ) multiplanar reconstruction ( mpr ) ct scan images show the complete absence of the right pulmonary veins ; the left superior and inferior pulmonary veins ( arrows ) are well seen . the left atrial outline is smooth , and minimal soft tissue ( arrowhead ) is noted adjacent to it volume - rendered aortic angiogram ( posterior view ) shows a prominent right bronchial artery ( arrow ) . unilateral pulmonary atresia , without associated structural abnormalities of the heart , is a rare congenital anomaly . it is thought to result from a failure of incorporation of the common pulmonary vein into the left atrium.[24 ] it may occur in either lung , and shows no preference for either side . our cases presented with recurrent hemoptysis , with one patient also having recurrent chest infections . the chest radiographs in both the cases revealed a small ipsilateral hemithorax , with mediastinal shift to the same side and parenchymal opacities . the diagnosis was made with certainty on the basis of ct scans of the chest and 128-slice cta findings . these findings included a small hemithorax , ipsilateral mediastinal shift , and parenchymal opacities in the form of a ground -- glass haze ; in addition , there was septal thickening in one case and consolidation in the other case . septal thickening is likely related to dilatation of the pulmonary lymphatics and bronchial veins , due to the obstructed venous return . fibrosis of the lung parenchyma can also occur due to a combination of pulmonary venous infarction and chronic pulmonary edema.[57 ] in both cases , the ct scans revealed the absence of pulmonary veins , with confluent soft tissue in the mediastinum and a small ipsilateral pulmonary artery . angiographic studies demonstrated , in addition , bronchial vascular supply in both the cases and systemic parenchymal supply from the inferior phrenic artery in the first case . although the development of bronchial artery collaterals is known in some cases of pulmonary venous atresia , to the best of our knowledge , the demonstration of these and systemic collaterals on cta has not been emphasized in previous reports . it has been suggested that the ipsilateral pulmonary artery is diminutive in these cases , likely because of preferential pulmonary artery perfusion to the contralateral side , with resultant impaired growth of the affected pulmonary artery . it is possible that this accounts for the systemic - to - pulmonary artery collaterals in these cases . rupture of dilated bronchial veins is one of the causes of hemoptysis is these patients . the confluent mediastinal soft tissue may suggest a mass lesion or fibrosing mediastinitis resulting in ipsilateral pulmonary artery and pulmonary vein obstruction . however , the presence of a small hemithorax without evidence of bronchial obstruction should suggest a congenital anomaly . the confluent soft tissue mass can be attributed to venous collaterals . noninvasive diagnosis of unilateral pulmonary venous atresia by cta , cardiac mri , or bronchoscopy has been described in recent publications . ct scan in a manner similar to mri provides accurate morphological information concerning the heart and extracardiac vascular structures . in both of our patients , conventional angiography was not done as the depiction of both the venous and arterial abnormalities was excellent on the 128-slice cta . here , we emphasize the ability of multislice ( 128-slice ) scan to conclusively establish the diagnosis of pulmonary venous atresia and thus obviate the need for conventional angiography .
unilateral pulmonary venous atresia is an uncommon entity that is generally believed to be congenital . 
 most patients present in infancy or childhood with recurrent chest infections or hemoptysis . 
 pulmonary angiography is usually used for definitive diagnosis . 
 however , the current multislice ct scanners may obviate the need for pulmonary angiography . 
 we report two cases diagnosed using 128-slice ct angiography . on the ct angiography images both these cases demonstrated absent pulmonary veins on the affected side , with a small pulmonary artery and prominent bronchial or other systemic arterial supply .