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Pulmonary Vascular Disease |

Line in the Lung! Whose Line Is It Anyway?

Penchala Mittadodla, MD; Deepak Chandra, MD; Mohan Rudrappa, MD; Brendon Colaco, MD; Clinton Colaco, MD; Raghu Reddy, MD
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University of Arkansas for Medical Sciences, Little Rock, AR


Chest. 2014;146(4_MeetingAbstracts):872A. doi:10.1378/chest.1994649
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Abstract

SESSION TITLE: Pulmonary Vascular Case Report Posters

SESSION TYPE: Affiliate Case Report Poster

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

INTRODUCTION: Partial anomalous pulmonary venous connections draining into right-sided circulation are prevalent in approximately 0.4 - 0.7 % of population based on radiological and autopsy studies [1]. Accidental discovery of anomalous pulmonary venous return with insertion of peripherally inserted central catheter (PICC) have rarely been reported. We describe our journey to the discovery of anomalous left superior pulmonary vein draining into left brachiocephalic vein and review its clinical significance.

CASE PRESENTATION: A 68-year-old man had a PICC placement at bedside due to difficulty in obtaining a peripheral intravenous line. A chest x-ray was done to confirm the position of PICC placement. It appeared as though the line was in the left lung parenchyma [A]. Blood sample was drawn to confirm its intravascular position. Although the PICC was inserted through left basilic vein, aspiration from the catheter revealed bright red blood. Blood gas analysis had a PaO2 of 105 mm Hg and SaO2 of 96% on room air, confirming an arterial sample. A CT scan of chest performed to study the placement of PICC and the anatomy of thoracic vasculature, revealed the catheter passing in the left brachiocephalic vein into left superior pulmonary vein via a persistent vertical vein [B]. A 3D-reconstruction of CT scan of chest illustrates an anomalous left superior pulmonary vein draining into left brachiocephalic vein through a persistent left vertical vein [C]. The catheter was repositioned before further use.

DISCUSSION: The case described above is a type of partial anomalous pulmonary venous drainage and is an extracardiac left to right shunt. Most of these patients are clinically asymptomatic except when the contralateral lung function is impaired as a result of lung disease or surgery like lobectomy or pneumonectomy.[2] Surgical correction may be needed for persistent hypoxemia due to shunting in these cases.

CONCLUSIONS: Partial anomalous pulmonary venous return should be considered in the differential diagnosis of persistent hypoxemic respiratory failure and need to be ruled out prior to surgical resection of the contralateral lung.

Reference #1: Haramati LB, Moche IE, Rivera VT, Patel PV, Heyneman L, McAdams HP, Issenberg HJ, White CS. Computed tomography of partial anomalous pulmonary venous connection in adults. J Comput Assist Tomogr. 2003 Sep-Oct;27(5):743-9.

Reference #2: Healey JA. An anatomic survey of anomalous pulmonary veins: their clinical significance. J Thorac Cardiovasc Surg 1952;23:433-4.

DISCLOSURE: The following authors have nothing to disclose: Penchala Mittadodla, Deepak Chandra, Mohan Rudrappa, Brendon Colaco, Clinton Colaco, Raghu Reddy

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