Pulmonary Vein in a Pinch

Abstract

The pulmonary veins normally drain into the left atrium, with the superior pulmonary veins typically situated anterior and inferior to the right pulmonary arteries. However, anomalies can happen. We encountered an exceedingly rare pulmonary vascular anomaly for a patient presenting with atypical chest pain, where the right superior pulmonary vein aberrantly ran posterior to the right pulmonary artery (RPA) and became compressed between the RPA and the right main bronchus. Coronary computed tomography angiography identified this specific pulmonary vein anomaly but revealed unremarkable coronary arteries.

Keywords: chest pain; computed tomography (CT); coronary computed tomography angiography (CCTA); echocardiography; pulmonary vein anomaly; pulmonary vein compression.

Figure 1

(A) A contrast-enhanced axial chest computed tomography (CT) scan shows the right superior pulmonary vein (RSPV) is aberrantly coursing between the right pulmonary artery (RPA) and the right main bronchus (RMB), and it is compressed in this anatomical configuration. (B) A contrast-enhanced chest CT image shows the RSPV compressed between the RPA and RMB. (C) A 3-dimensional CT image shows the RSPV anterior to the RMB and flattened due to compression by the RPA and RMB.