Figure 1
CT scan of the chest at the level of the aortic arch
a vertical vessel is seen left to the aortic arch (arrow). The (right) superior vena cava is in a normal position.
Clinical History
CT findings are characteristic of a vertical vein, an anomalous venous return of the left superior pulmonary lobe.
Imaging Findings
A chest computed tomography (CT) is performed 4 years after a right inferior pulmonary lobectomy for lung cancer in a patient. Preoperative CT had demonstrated a left superior vena cava.
On CT scan of the chest at the level of the aortic arch a vertical vessel is seen left to the aortic arch (arrow). The (right) superior vena cava is in a normal position.
On CT scan of the chest at the level of the left main bronchus (star) the left superior pulmonary vein is not seen in its normal position i.e. anteriorly to the left main bronchus.
On CT scan of the chest, pulmonary window setting at the level of the aortico-pulmonary recess, pulmonary veins are branching toward the anomalous mediastinal vein.
On CT scan of the chest with coronal reconstruction there is branching of the left upper lobe pulmonary veins into the mediastinal vein (arrow).
AO = Aortic arch.
LPA = left pulmonary artery.
CT findings are characteristic of a vertical vein, an anomalous venous return of the left superior pulmonary lobe.
On CT scan of the chest at the level of the aortic arch a vertical vessel is seen left to the aortic arch (arrow). The (right) superior vena cava is in a normal position.
On CT scan of the chest at the level of the left main bronchus (star) the left superior pulmonary vein is not seen in its normal position i.e. anteriorly to the left main bronchus.
On CT scan of the chest, pulmonary window setting at the level of the aortico-pulmonary recess, pulmonary veins are branching toward the anomalous mediastinal vein.
On CT scan of the chest with coronal reconstruction there is branching of the left upper lobe pulmonary veins into the mediastinal vein (arrow).
AO = Aortic arch.
LPA = left pulmonary artery.
CT findings are characteristic of a vertical vein, an anomalous venous return of the left superior pulmonary lobe.
Discussion
A vertical vein represents one third of all venous pulmonary abnormalities and is seen in 2% of all congenital cardiac malformations. Instead of draining into the left auricle, the blood of the left upper lobe is drained into the superior vena cava through a vertical ascending mediastinal vein and the left brachiocephalic vein. The appearance of the vertical vein is similar to that of another congenital variant, the left superior vena cava (LSVC), much more frequent, seen in 0.3% of all individuals and draining into the coronary sinus. The LSVC and the vertical vein originate from the anterior cardinal vein. Chest CT scan allows a correct diagnosis by demonstrating the precise anatomy. Differential diagnosis is made on cross sectional images. Normally only the left superior vein is seen anteriorly of the left main stem bronchus. In case of LSVC, two veins are seen while in case of a vertical vein, there are no veins in this location. MRI gives additional information about the direction of the blood flow, craniocaudal in the LSVC and caudocranial in the vertical vein. A non-cyanotic and asymptomatic left to right shunt is associated with the vertical vein. Clinically respiratory impairment may be seen if a massive pulmonary tromboembolism occurs or after a right pulmonary lobectomy or pneumonectomy. Our patient had no impairment after his right inferior lobectomy.
Differential Diagnosis List
Vertical vein
Final Diagnosis
Vertical vein
References
[1] Dillon EH, Camputaro C. Partial anomalous pulmonary venous drainage of the left upper lobe versus duplication of the superior vena cava: distinction based on CT findings. AJR 1993; 160: 375-379. (PMID: 8424355)
[2] Gris P, Wilmet B, Benchillal A et al. Veine cave sup退rieure gauche persistante. A propos de deux observations. Rev Pneumol Clin 1995; 51: 33-35. (PMID: 7740264)
[3] Pennes DR, Ellis JH. Anomalous pulmonary venous drainage in relation to the left superior vena cava and coronary sinus. Radiology 1986; 159: 23-24. (PMID: 3952312)
[4] White CS, Baffa JM, Haney PJ et al. MRImaging of congenital anomalies of the thoracic veins. Radiographics 1997; 17: 595-608. (PMID: 9153699)
Case information
| URL: | https://www.eurorad.org/case/1486 |
| DOI: | 10.1594/EURORAD/CASE.1486 |
| ISSN: | 1563-4086 |
Figure 2
CT scan of the chest at the level of the left main bronchus (star)
the left superior pulmonary vein is not seen in its normal position i.e. anteriorly to the left main bronchus.
Figure 3
CT scan of the chest
pulmonary window setting at the level of the aortico-pulmonary recess, pulmonary veins are branching toward the anomalous mediastinal vein.
Figure 4
CT scan of the chest with coronal reconstruction
there is branching of the left upper lobe pulmonary veins into the mediastinal vein (arrow). AO = Aortic arch. LPA = left pulmonary artery.
CT scan of the chest at the level of the aortic arch
a vertical vessel is seen left to the aortic arch (arrow). The (right) superior vena cava is in a normal position.
CT scan of the chest at the level of the left main bronchus (star)
the left superior pulmonary vein is not seen in its normal position i.e. anteriorly to the left main bronchus.
CT scan of the chest
pulmonary window setting at the level of the aortico-pulmonary recess, pulmonary veins are branching toward the anomalous mediastinal vein.
CT scan of the chest with coronal reconstruction
there is branching of the left upper lobe pulmonary veins into the mediastinal vein (arrow). AO = Aortic arch. LPA = left pulmonary artery.