Integrated diagnostic cardiac imaging in a patient with dyspnoea

Clinical History

After a successfully treated bronchopneumonia, the patient reported stress dyspnoea. Echocardiography was performed.

Imaging Findings

Transthoracic Echocardiography: dilated right chambers.
Transesophageal echocardiography: interatrial defect venous sinus type.
Cardiac Magnetic Resonance: T1 sequences: no signs of fatty infiltration (excluding arrhythmogenic right ventricular dysplasia); T2 sequences: not signs of oedema (excluding myocarditis); contrast delayed-enhancement: negative; phase contrast sequences: pulmonary/aortic flow ratio of 1.6, indicative of intracardiac shunt.
Contrast Computed Tomography: right caudal lung vein returning in the lower vena cava.

Discussion

The anomalous venous return is a wrong drainage of the lung veins in a venous vascular structure and/or the right atrium. Anomalous venous returns are more frequent in males; in 80-90% of patients they are associated with an atrial septal defect.
In this case we observed a return of the right caudal pulmonary vein in the lower vena cava with a QP/QS ratio of 1, 6. [1] The right chamber showed signs of volume overload. A venous sinus type atrial defect was associated, which was diagnosed by transesophageal, not transthoracic, echocardiography, as often occurs.
The anomalous position of the anomalous pulmonary vein also required integrated diagnostic imaging, with contrast CT needed for final diagnosis, as shown in the illustrations.

Differential Diagnosis List

Final Diagnosis

Anomalous venous return

URL:	https://www.eurorad.org/case/9632
DOI:	10.1594/EURORAD/CASE.9632
ISSN:	1563-4086