CASE REPORT   

Il Giornale Italiano di Radiologia Medica 2019 Novembre-Dicembre;6(6):606-11

DOI: 10.23736/S2283-8376.19.00244-4

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English, Italian

Left-sided partial anomalous pulmonary venous return associated with secondary obstruction of the left innominate vein

Antonino CINCOTTA ¹ ✉, Pietro GEMMA ¹, Francesco ARPAIA ¹, Renato VITALE ¹, Ettore COLOMBO ², Angelo VANZULLI ^{2, 3}

¹ School of Specialization in Radiodiagnostics, University of Milan, Milan, Italy; ² Department of Diagnostic and Interventional Radiology, Niguarda Ca’ Granda Hospital, Milan, Italy; ³ Department of Oncology and Hemato-Oncology, Niguarda Ca’ Granda Hospital, University of Milan, Milan, Italy

Partial anomalous pulmonary venous return (PAPVR) is an uncommon clinical condition characterized by the abnormal return of one or more pulmonary veins to the systemic venous circulation. PAPVR causes already oxygenated blood coming from pulmonary venous system to flow back into arterial pulmonary circulation (right-to-left shunt). In cases where only one pulmonary vein is involved, there are no visible symptoms, and patients do not suffer from hemodynamic alterations nor cardiac structural modifications. The disease is often discovered fortuitously during autopsies or medical imaging diagnoses performed for other examinations. Here we present a case study characterizing an anomalous connection of the left superior pulmonary vein to the left innominate vein, discovered during a computed tomography (CT) scan performed to restage a Hodgkin’s lymphoma. This case is unique in that localization of the lymphoma to the mediastinum, and subsequent radiotherapy treatment, resulted in full obliteration of the left innominate vein downstream of the anomalous pulmonary venous return. After the injection of iodinated contrast agent through the left brachial vein, it was possible to visualize the reverse passage of the contrast medium from the obstructed left innominate vein to the left inferior pulmonary vein with premature opacification of both left cardiac chambers and aorta. To the authors’ knowledge, this is the first reported case of left PAPVR on an obstructed left innominate vein.

KEY WORDS: Scimitar syndrome; Brachiocephalic veins; Hodgkin disease