PMC5220406_01
(a) Cardiac computed tomography angiogram. (b) 3D reconstruction of the left atrium. Green arrows indicating filling and perfusion defect of the left superior pulmonary vein suggesting an ostial stenosis.
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fig1
A higher resolution cardiac CT angiogram (Figure 1(a)) and left atrium 3D reconstruction (Figure 1(b)) was used to confirm subtotal occlusion of the left superior pulmonary venous trunk.
Lung perfusion scan. Patient's left lung perfusion was significantly diminished compared to right. This finding suggests development of pulmonary artery blood flow redistribution via systemic arterial collaterals in response to the left superior pulmonary vein stenosis.
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A lung perfusion scan revealed significantly decreased left upper lung perfusion (Figure 2) with the left lung contributing approximately 18% of the lung function and the right lung contributing 82% of the total lung function.
(a) Normal right pulmonary angiogram. Venous return confined to the area of the lung supplied by the arterial vasculature. No evidence of collateral development. (b) Left pulmonary angiogram. Green arrow demonstrating pulmonary arterial collateral from left upper lobe to the mid segment of the left lung.
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fig3
The levophase pulmonary angiogram demonstrated well developed collateral circulation from the left upper lobe to the mid segment of the left lung (Figures 3(a) and 3(b), resp.).