PMC4278095_01
37-year old female who presented with dyspnea and hypoxia with a diagnosis of levoatriocardinal vein. Axial images from contrast-enhanced CT scan of the chest demonstrate the abnormal vessel. (a) Image at the level of the left brachiocephalic vein shows connection with the anomalous vein (arrow). (b) Image at the level of the aortic arch shows bright undiluted contrast within the anomalous vein (arrow). (c) Image at the level of the left atrium shows bright undiluted contrast in the left superior pulmonary vein (arrow) draining into the left atrium (LA). Thus, the inferiorly directed flow through the anomalous vein produces an extracardiac right-to-left shunt.
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F1
The CT scan was negative for pulmonary embolism, but did reveal an anomalous vein connecting the left brachiocephalic vein to the left superior pulmonary vein [Figures 1 and 2 and Video 1].
37-year-old female who presented with dyspnea and hypoxia with a diagnosis of levoatriocardinal vein. Reformatted images from chest CT scan demonstrate the abnormal vessel. (a) Reformatted coronal image shows flow through the levoatriocardinal cardinal vein (arrow) to the left superior pulmonary vein (arrowhead). (b) Volume-rendered image from an anterior perspective shows the levoatriocardinal vein (large arrow) connecting the left brachiocephalic vein (BCV) to the left superior pulmonary vein (arrowhead). Note small pulmonary venous branches (small arrows) connecting to the anomalous vessel. SVC = Superior vena cava; LA = Left atrium.
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F2
The CT scan was negative for pulmonary embolism, but did reveal an anomalous vein connecting the left brachiocephalic vein to the left superior pulmonary vein [Figures 1 and 2 and Video 1].
37-year year-old female who presented with dyspnea and hypoxia with a diagnosis of levoatriocardinal vein. Contiguous axial images from contrast-enhanced CT scan of the chest demonstrate the abnormal vessel. Beginning at the level of the left brachiocephalic vein, bright undiluted contrast drains inferiorly as it flows through the anomalous vessel, to the left superior pulmonary vein, and finally into the left atrium. Therefore, this flow demonstrates an extra-cardiac right-to-left shunt.
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F3
MRI of the anomalous vein was also performed to evaluate the flow characteristics [Figure 3].