MR Imaging and CT Evaluation of Congenital Pulmonary Vein Abnormalities in Neonates and Infants

Abstract

Magnetic resonance (MR) imaging and computed tomography (CT) are increasingly being used in diagnosis and follow-up of congenital pulmonary vein anomalies in neonates and infants. Such anomalies include total or partial anomalous pulmonary venous return, sinus venosus defect, malposition of the septum primum, cor triatriatum, pulmonary vein atresia or stenosis, and abnormal number or course of the pulmonary veins. MR imaging provides a wealth of anatomic and functional data that are valuable in case management and planning intervention. Gadolinium-enhanced MR angiography is the mainstay of anatomic evaluation. Ventricular volumetry with two-dimensional steady-state free-precession sequences and flow analysis with cine phase-contrast imaging provide physiologic information that may be used to calculate the degree of right heart enlargement and the shunt fraction, allowing the cardiologist to determine the functional importance of the lesion. CT provides superior spatial resolution and short imaging times but at the expense of exposure to ionizing radiation.

Total Anomalous Pulmonary Venous Connection in Children: Preoperative Evaluation with Low-Dose Multidetector Computed Tomographic Angiography

“…Diagnostic images (image quality scores, ≥3) were obtained in all the acquisitions (100%). The mean imagequality score was 4.2 ± 0.8 (range, [3][4][5]. The average attenuation in both the ascending aorta and pulmonary trunk was 442 ± 118 and 440 ± 115 HU, respectively.…”

“…Unusually, the vertical vein passes between the left pulmonary artery and the left bronchus, leading to pulmonary venous obstruction. 4 Rarely, the site of entrance to the brachiocephalic vein is also narrowed, and this leads to obstruction. In the present study, children with supracardiac TAPVC accounted for 42% of the obstructed veins, and for all obstructions at the entrance to the systemic veins.…”

“…4 These imaging methods help overcome the shortcomings of transthoracic echocardiography (TTE), which gives a suboptimal acoustic window and a poor depiction of extracardiac vascular structures. They are also an improvement over catheter angiography, which produces overlapping views of adjacent vascular structures, causes difficulty in the simultaneous depiction of the systemic and pulmonary vascular systems, leads to undesirable catheter-related sequelae, and delivers relatively high doses of ionizing radiation.…”

Main pulmonary artery trifurcation in association with persistent right common pulmonary vein: a piece of embryological puzzle

“…CPV further divides into right and left branches. As the LA starts growing, the CPVs on either side gradually get absorbed into the LA, resulting in four separate veins opening into LA (6,7). In our case there appears to be incomplete absorption of CPV into LA leading to persistent rCPV.…”

Heterotaxy syndrome: a case report

“…The multiplicity and diversity of findings in such a syndrome make the individualization of cases extremely valuable, as most of them do not perfectly fit in any classification Thus, the radiological evaluation is indispensable for the identification and planning of the approach to patients presenting cardiac and immunological complications or surgical conditions, allowing for the evaluation of the alterations present in each patient (8) .…”