Evaluation of pulmonary venous variations in a large cohort : Multidetector computed tomography study with new variations

Abstract

Objective: The aim of this study was to assess pulmonary venous anatomy and to determine the frequency of each drainage pattern in a large cohort using multidetector computed tomography (MDCT) and three-dimensional (3D) imaging.

Material and methods: The chest CT images of 550 patients were retrospectively reviewed for pulmonary venous anatomy and variant patterns. All CT scans were performed using a 128 detectors row CT scanner after intravenous contrast administration. Pulmonary venous drainage pattern was documented for each patient and frequency of each drainage type was calculated. A useful classification system was used to simplify complex pulmonary venous anatomy.

Results: The expected typical anatomy was observed in 239 (43.5%) patients. The remaining 311 (56.5%) patients had anatomic variations on the right, left, or both sides. The most common variation was left common vein, seen in 177 (32.2%) patients, followed by accessory right middle lobe vein(s), seen in 112 (20.4%) patients. In the present study the frequency of variant anatomy on the right (34%) and left (33.3%) sides were similar.

Conclusion: The use of MDCT with 3D imaging is a preferable imaging tool for demonstrating pulmonary venous anatomy in detail, which shows significant variability. Considering the high prevalence of variations in the population, performing preprocedural MDCT may facilitate higher success rates in radiofrequency catheter ablation (RFCA) and help to perform safe and accurate surgery especially in video-assisted thoracic surgery (VATS).

Keywords: Anatomic variations; Atrial fibrillation; Computed tomography; Pulmonary venous anatomy; Thoracic surgery.