Anatomical Insights Into Profound Pulmonary Venous Malformation in an Elderly Individual: A Report of a Rare Cadaveric Case

Abstract

A male cadaver, 87 years of age, was received through the Saint Louis University Gift of Body Program. Significant pulmonary vein (PV) variations were observed following routine dissection. The donor displayed two normal left PVs and 10 significantly undersized right PVs. By caliper measurement, the left PVs had long axis diameters of 19 mm and 20 mm, while the right PVs ranged from 1 mm to 11 mm. The total cross-sectional area of the 10 right PVs was 173 mm² which was significantly less than the 429 mm² total cross-sectional area of the two left PVs. This was unexpected since the total diameter and cross-sectional area of right PVs are usually reported to be larger. While it is not uncommon for patients to have slight variations in the pulmonary venous structure, there are no known reports of individuals with 12 asymmetric PVs. Anatomical variation in the quantity and dimensions of PVs results in abnormal blood drainage and increased fluid resistance in the vessels, which could potentially contribute to cardiopulmonary sequelae. Appreciation of variations and their possible developmental underpinnings could allow for a better understanding of pathology and appropriate treatment for patients with anomalous vessels and cardiovascular diseases. For example, recent correlations between PV defects, atrial fibrillation, and ectopic heartbeats have been elucidated. Individuals with abnormal PVs have been found to express higher rates of ectopic foci resulting in atrial fibrillation. Successful resolution of ectopic foci via radiofrequency catheter ablation requires accessory PVs to be effectively identified and accounted for when evaluating treatment options. As such, a comprehensive understanding of both typical and atypical pulmonary vasculature prompts refinement of interventional procedures for maximal safety and efficacy for these patients.

Keywords: accessory pulmonary veins; embryology; pulmonary abnormalities; pulmonary vein variations; vessel anomalies.

Figure 1. Pairing of accessory pulmonary veins between the right lung and the heart

Pairing of accessory pulmonary veins between the right lung (A) and the heart (B). Each accessory vein links to a corresponding ostium. Each ostium of an accessory PV is indicated by a number labeled on the heart and lung. A red label indicates connection to the right upper lobe. A blue label indicates connection to the right middle lobe. A purple label indicates connection to the right lower lobe. Note that the right PV 2 was associated with both the right upper and right middle lobes. PV: Pulmonary vein

Figure 2. Views of aberrant pulmonary vein ostia opening into the left atrium

Panel A: Right-sided accessory PVs (7, 8, 9, 10); Panel B: Right-sided accessory PVs (1, 2, 3, 4, 5, 7); Panel C. Right-sided accessory PVs (4, 5, 6, 7); Panel D. Normal left superior (1) and inferior PVs (2). A red label indicates connection to the right upper lobe. A blue label indicates connection to the right middle lobe. A purple label indicates connection to the right lower lobe. A green label indicates left-sided PVs. PV: Pulmonary vein

Figure 3. Views of aberrant pulmonary veins at the hila of the lungs

Panel A. Right-sided PVs (1-10). Panel B. Left PVs (1,2). A red label indicates connection to the right upper lobe. A blue label indicates connection to the right middle lobe. A purple label indicates connection to the right lower lobe. A green label indicates left-sided PVs. PV: Pulmonary vein