PMC4898072_01
PMC4898072_02
62-year-old woman with chronic hypoxemia. Perfusion images reveal significant extrapulmonary radiotracer activity in kidneys (orange), bowel, and thyroid gland (green). Radionuclide ventilation images (not shown) were unremarkable.
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Radionuclide ventilation and perfusion imaging performed on an outpatient basis revealed significant increased radiotracer activity in the kidneys, bowel, and thyroid gland along with unremarkable ventilation images (Figure 1).
62-year-old woman with chronic hypoxemia. A large right-to-left shunt was confirmed on contrast-enhanced CT of the chest utilizing a left upper-extremity venous injection (red).
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However, to our surprise, the shunt was noted to be pre-cardiac as opposed to intracardiac (Figure 2, Figure 3, Figure 4, Figure 5, Figure 6).
62-year-old woman with chronic hypoxemia. Immediate and equivalent opacification of the aortic arch (gold) is noted when compared to the left brachiocephalic vein (red).
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However, to our surprise, the shunt was noted to be pre-cardiac as opposed to intracardiac (Figure 2, Figure 3, Figure 4, Figure 5, Figure 6).
62-year-old woman with chronic hypoxemia. An anatomically correct right-sided SVC drains through two channels, the larger of which empties into the left atrium (blue) with a smaller atretic portion (red) feeding the right atrium.
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fig4
However, to our surprise, the shunt was noted to be pre-cardiac as opposed to intracardiac (Figure 2, Figure 3, Figure 4, Figure 5, Figure 6).
62-year-old woman with chronic hypoxemia. An anatomically correct right-sided SVC drains through two channels, the larger of which empties into the left atrium (blue) with a smaller atretic portion (red) feeding the right atrium. The ascending and descending thoracic aorta are again noted to be of equivalent opacity as compared to the right-sided venous structures on this immediate post-injection image.
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fig5
However, to our surprise, the shunt was noted to be pre-cardiac as opposed to intracardiac (Figure 2, Figure 3, Figure 4, Figure 5, Figure 6).
62-year-old woman with chronic hypoxemia. A paucity of contrast is noted in the RV (blue) as compared to LV and aorta (gold), which is an abnormal finding on this early venous phase image.
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However, to our surprise, the shunt was noted to be pre-cardiac as opposed to intracardiac (Figure 2, Figure 3, Figure 4, Figure 5, Figure 6).
62-year-old woman with chronic hypoxemia. Coronal 3-D reconstructed image reveals the small atretic segment of the SVC (red) feeding the right atrium (green), and the larger segment (blue) feeding the left atrium (purple).
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An anatomically correct right-sided SVC was demonstrated to drain through two channels, the larger of which emptied into the roof of the left atrium with a smaller atretic portion feeding the right atrium (Figure 7).
62-year-old woman with chronic hypoxemia. Volume rendered images from a cardiac MRA demonstrate partial anomalous pulmonary venous return (green) to the SVC (red) which was not appreciated on the contrast-enhanced CT of the chest. Blue - Left atrium, Yellow - Aorta, Light blue - Right pulmonary vein
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Evidence of partial anomalous pulmonary venous return was demonstrated on the cardiac MRI/MRA with a right upper lobe pulmonary vein draining to the superior vena cava (Figure 8).