PMC7290260_01
The patient's 12-lead electrocardiogram:sinus tachycardia (R-R interval underscored with the black line) with an incomplete right bundle branch block, right ventricular hypertrophy (identified by the black arrows), and subtle secondary ST-T segment changes.
10.1177_2324709620933425-fig1.jpg
PMC7290260_01_10.1177_2324709620933425-fig1.jpg
fig1-2324709620933425
A 12-lead electrocardiogram revealed sinus tachycardia with an incomplete right bundle branch block, right ventricular hypertrophy, and subtle secondary ST-T segment changes (see Figure 1).
The patient's chest radiograph (CXR):large-sized, right pleural effusion (enclosed by the red box) with mild perihilar congestion.
10.1177_2324709620933425-fig2.jpg
PMC7290260_01_10.1177_2324709620933425-fig2.jpg
fig2-2324709620933425
A portable chest radiograph revealed a large-sized, right pleural effusion with mild perihilar congestion (see Figure 2).
The patient's 2-dimensional transesophageal echocardiogram. (A) Intact interatrial septum with agitated saline "bubble" study. (B) Incomplete visualization of the left and right pulmonary veins (PVs):the left and right inferior PVs could not be imaged.
10.1177_2324709620933425-fig3.jpg
PMC7290260_01_10.1177_2324709620933425-fig3.jpg
fig3-2324709620933425
The PVs were incompletely visualized and hence the rationale for further advanced imaging (see Figure 3).
The patient's cardiac computed tomography angiogram. (A) Cross-sectional view of the location of the anomalous left inferior pulmonary vein (PV) in relation to other cardiac structures. (B) Coronal section of the course of the left inferior PV with its relation to the pulmonary artery.
10.1177_2324709620933425-fig4.jpg
PMC7290260_01_10.1177_2324709620933425-fig4.jpg
fig4-2324709620933425
A cardiac CT angiogram (CCTA) affirmed the presence of the suspected PAPVC of the left inferior PV to the left brachiocephalic (innominate) vein with angiographically normal coronary arteries (see Figure 4).
The patient's cardiac magnetic resonance imaging scan. (A) Cross-sectional view of the location of the anomalous left inferior pulmonary vein (PV) in relation to other cardiac structures. (B) Sagittal section showing the connection of the left inferior PV to the innominate (brachiocephalic) vein. (C) Sagittal section showing the engorged, dilated pulmonary venous vasculature, reflecting the hemodynamically significant left-to-right shunt and increased transpulmonary flow.
10.1177_2324709620933425-fig5.jpg
PMC7290260_01_10.1177_2324709620933425-fig5.jpg
fig5-2324709620933425
The patient also underwent cardiac magnetic resonance imaging (CMRI), which demonstrated the same aberrant connection with the remaining pulmonary venous vasculature appearing dilated in addition to the RA, right ventricle, and main pulmonary artery (see Figures 5 and 6, respectively).
The patient's cardiac magnetic resonance imaging scan. (A) Right ventricular (RV) outflow tract view indicating the moderately dilated main pulmonary artery (PA). (B) Coronal section of the course of the left inferior pulmonary vein with its relation to the PA. (C) Apical 4-chamber view indicating the moderately dilated right atrium (RA). (D) Apical 4-chamber view indicating the moderately dilated RV.
10.1177_2324709620933425-fig6.jpg
PMC7290260_01_10.1177_2324709620933425-fig6.jpg
fig6-2324709620933425
The patient also underwent cardiac magnetic resonance imaging (CMRI), which demonstrated the same aberrant connection with the remaining pulmonary venous vasculature appearing dilated in addition to the RA, right ventricle, and main pulmonary artery (see Figures 5 and 6, respectively).