CTICasesLeft Superior Intercostal Vein to Pulmonary Vein Shunt in Chronic Thromboembolic Pulmonary Hypertension
Imaging findings
Contrast-enhanced CT of the chest demonstrates findings of chronic thromboembolic pulmonary hypertension with mosaic perfusion, extensive pulmonary arterial thrombi, and hypertrophied bronchial arteries. A dilated systemic-to-pulmonary venous collateral is identified as the left superior intercostal vein (representing a persistent levoatrial cardinal vein), which drains blood from the left brachiocephalic vein directly into the left superior pulmonary vein and left atrium.
Key takeaways
High systemic venous pressures caused by severe pulmonary hypertension can open embryonic collateral channels, such as a connection between the left superior intercostal vein and the left superior pulmonary vein. This can act as an acquired systemic-to-pulmonary venous shunt, leading to an early right-to-left shunt visible on bubble echocardiography.
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