Echocardiographic Diagnosis of Pulmonary Vein Varix

Abstract

ulmonary vein varix is a rare abnormality, often presenting as a pulmonary or mediastinal mass on chest roentgenograms, and pulmonary angiography, computed tomography (CT), or magnetic resonance imaging (MRI) is considered necessary for diagnosis. We describe our experience with an unusual case of pulmonary vein varix that was diagnosed noninvasively by echocardiography alone. Case ReportA 47-year-old woman was admitted because of chest discomfort. She did not have a history of cardiovascular disease and the results of physical examination, routine blood tests and electrocardiography were unremarkable. Chest radiography suggested a mediastinal mass inside the left cardiac border in the posteroanterior view ( Fig 1A) and behind the cardiac silhouette in the lateral view (Fig 1B). Two-dimensional transthoracic echocardiography (TTE) was performed. On the parasternal long-axis view, the motion and chamber size of the left ventricle were normal, and there was no enlargement of the left atrial or right ventricular chambers. On the short-axis view and apical 4-chamber view, an echo-free mass was observed outside the posterolateral wall of the left atrium (Fig 2A,B). There was no indentation of the left ventricular wall, suggesting that the mass was an extrapericardial structure. Color Doppler echocardiography detected blood flow from the mass into the left atrium (Fig 2C). Mitral regurgitation was not evident. Transesophageal echocardiography (TEE) more clearly demonstrated dilatation of the pulmonary vein in the proximal left lower lobe with normal intrapulmonary venous connections (Fig 3A,B). The varix communicated with the left atrium. The right pulmonary veins and left upper pulmonary vein were normal. The wall of the varix was Pulmonary vein varix is a rare abnormality, often resembling a pulmonary or mediastinal mass on chest radiographs, and pulmonary angiography has been the mainstay of diagnosis. An unusual case of pulmonary vein varix was clearly defined by echocardiography performed in a 47-year-old woman with chest discomfort who had been found to have an abnormal structure behind the cardiac silhouette on a chest radiograph.

Pulmonary venous varix associated with mitral regurgitation mimicking a mediastinal mass: A case report and review of the literature

“…On chest radiography, the PVV may mimic a mediastinal or perihilar mass, such as in our case. Other differentials of mediastinal masses include mediastinal lymphadenopathy either infectious or lymphoproliferative, bronchogenic carcinoma, foregut duplication cysts, cor triatriatum, and left atrial aneurysm or diverticuli [15] , [16] . Thus, it is important to emphasize the benign nature of varices before any procedure or biopsy [5] , [11] .…”

Large pulmonary masses containing varicose veins: a rare presentation of benign metastasising leiomyomas

“…Pulmonary varices are a rare venous abnormality, usually discovered as an incidental finding [1,5,6]. The most frequently reported cardiac lesion associated with pulmonary varices is mitral valve disease, which includes mitral stenosis and mitral regurgitation [7].…”

“…The most frequently reported cardiac lesion associated with pulmonary varices is mitral valve disease, which includes mitral stenosis and mitral regurgitation [7]. Some reports have suggested a congenital predisposition to pulmonary varices, with acquired conditions like pulmonary venous hypertension causing dilatation of pre-existing abnormal vessels that dilate further to become varices [1,6,7]. Most patients do not have symptoms that are directly related to the pulmonary varices [6,7].…”

“…Some reports have suggested a congenital predisposition to pulmonary varices, with acquired conditions like pulmonary venous hypertension causing dilatation of pre-existing abnormal vessels that dilate further to become varices [1,6,7]. Most patients do not have symptoms that are directly related to the pulmonary varices [6,7]. Therefore, surgical intervention is not generally recommended [1,6], even though the varices may cause massive haemoptysis with bleeding into a bronchus or can be the source of emboli to the circulation owing to thrombosis within the varices [5,7].…”

“…Most patients do not have symptoms that are directly related to the pulmonary varices [6,7]. Therefore, surgical intervention is not generally recommended [1,6], even though the varices may cause massive haemoptysis with bleeding into a bronchus or can be the source of emboli to the circulation owing to thrombosis within the varices [5,7]. Lung varices within lung masses have not been previously reported.…”