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Meandering Pulmonary Vein: Very Rare Incidental Finding FREE TO VIEW

Murat Aygun, MD; Mustafa Calik, MD; Suleyman Baktik, MD; Fulden Aygun, MD; Saniye Calik, MD; Taha Bekci, MD; Hidir Esme, MD
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Department of Thoracic Surgery, Konya Education and Research Hospital, Konya, Turkey

Chest. 2014;146(4_MeetingAbstracts):423A. doi:10.1378/chest.1994620
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SESSION TITLE: Miscellaneous Global Case Reports

SESSION TYPE: Global Case Report

PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM

INTRODUCTION: Meandering right pulmonary vein (MRPV) is a rare pulmonary vascular anomaly which confused with the more common scimitar syndrome. Both conditions consist of an anomalous right pulmonary vein, taking a circuitous route through the lung, usually results in a scimitar sign or mimic A-V malformation on chest X-ray. However in contrast to scimitar syndrome, the MRPV terminates normally in the left atrium, rather than the inferior vena cava. Also absence of feeding artery is main point for differentiating MPRV from A-V malformation (1). Herein we report a case report of a 30-years-old male which mimic A-V malformation.

CASE PRESENTATION: A 30 years-old man was referred to our clinic for pulmonary nodule detected in routine evaluation before job entrance. Pulmonary CT angiography showed dilated venous structure without any feeding vessel. Patient underwent angiography for exclusion A-V malformation but no feeding vessel was detected, but an abnormal vein drained to left atrium. Diagnosis of meandering pulmonary vein was made under existing findings. Colored 3D volume rendering images of CT angiography was reconstructed by using workstation; and it showed abnormal drainage of upper lob pulmonary vein to the inferior pulmonary vein and form abnormal common pulmonary vein which shouldn’t be exist (Figure 3). Because of any symptoms no further examination was recommended.

DISCUSSION: The term “meandering right pulmonary vein” was subsequently coined by Goodman et al (2) to describe the presence of the scimitar sign and an anomalous right pulmonary vein that drains normally into the left atrium. According to our best knowledge to date only 17 cases reported in the literature. In contrast to scimitar syndrome and A-V malformation, there have only been a handful of cases of MRPV reported in the literature.

CONCLUSIONS: The diagnosis of MRPV has changed dramatically thanks to advances in CT technology. But some cases angiography can be an optional imaging modality for excluding A-V malformation which must be treated by interventional procedures (3). Non-invasive diagnosis is possible with modern multislice CT technology through the use of detailed MPR and maximum intensity projections, which clearly demonstrate vessel anatomy.

Reference #1: Gilkeson RC, Haaga JR, Ciancibello LM. Anomalous unilateral single pulmonary vein multidetector CT findings. AJR Am J Roentgenol. 2000;175:1464-5.

Reference #2: Gwinn JL, Barnes GR. The scimitar syndrome. Anomalies of great vessels associated with lung hypoplasia. Am J Dis Child 1967; 114: 585-586

Reference #3: Tsang TK, Kwan TL, Wong WK, Fung HS, Wai AMW. Anomalous unilateral single pulmonary vein - a rare mimicker of pulmonary arteriovenous malformation. J HK Coll Radiol. 2007;10:16-8.

DISCLOSURE: The following authors have nothing to disclose: Murat Aygun, Mustafa Calik, Suleyman Baktik, Fulden Aygun, Saniye Calik, Taha Bekci, Hidir Esme

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