Presentation
Presented with increasing shortness of breath and cough. Was treated as viral pneumonia, however he developed increasing oxygen requirements and was admitted to intensive care unit.
Patient Data
Right sided tunneled line, ET and NG tubes noted in satisfactory positions. The left internal jugular catheter is also seen, however the tip is projecting over the left hilum, not obviously following the normal line of either the venous or arterial systems.
CTPA from previous admission
A review of the CTPA performed during a recent, previous admission demonstrated partial anomalous pulmonary venous return, with the left superior pulmonary vein draining directly into the left brachiocephalic vein. The subsequently placed left internal jugular central venous catheter had passed into this, giving the appearances seen on the radiograph above.
Case Discussion
Partial anomalous pulmonary venous return (PAPVR) is a rare anatomical variant with estimated prevalence of between 0.1 - 0.5%. Left upper lobe PAPVR is the most common type, and is least associated with other abnormalities. PAPVR causes an extra-cardiac left-to-right shunt, however this is often not clinically significant, thus patients may present late, or the diagnosis may be picked up incidentally on imaging (as was the case with this patient).
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