Partial anomalous pulmonary venous return of right upper pulmonary vein associated with sinus venosus ASD
Presentation
Presented with shortness of breath. No other data provided.
Patient Data
Chest radiographs
The electrode of the pacemaker destinated to right ventricle is placed in left ventricle topography, passing through the left atrium.
Prominent pulmonary markings, with an atypical morphology of right hilum.
Right hilar angle seems to be altered in its superior component.
Right upper pulmonary vein draining to superior vena cava is visualized.
There is a sinus venosus atrial septal defect, with electrode of pacemaker passing through and located in left ventricle.
Prominent pulmonary vascularization, secundary to increased blood supply to right cavities.
Case Discussion
Partial anomalous pulmonary venous return (PAPVR) is a rare entity that is frequently associated with atrial septal defects (ASD), so that when PAPVR is diagnosed, a cardiological study should be performed to rule out ASD (and vice versa).
In this case, the incidental finding of pacemaker malposition led to the realization of a CT scan, where both the atrial defect and the abnormal drainage were evidenced.
Likewise, this patient had signs of pulmonary hyper afflux due to the left-right shunt.
Sinus venosus ASD is a very rare entity (less than 10% of all ASD, according to some series) consisting of a septation defect of the pulmonary veins, vena cava and /or posterior wall of the right atrium. There are two types: upper venous sinus and inferior venous sinus.
The upper sinus venosus ASD is associated with superior anomalous drainage, and the inferior sinus venosus ASD is associated with inferior anomalous drainage.
So, to take home:
- look always at the pacemaker and where electrodes are located
- whenever you see an abnormal pulmonary drainage, look at the heart
- whenever you see an ASD, look for anomalous drains!
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