CTICasesLarge Right Upper Lobe Pulmonary Vein with Mass Effect on Bronchus Intermedius
Imaging findings
CT demonstrates an unusually large right upper lobe pulmonary vein that courses posteriorly to the bronchus intermedius before draining into the left atrium. The large vein exerts mass effect on the bronchus intermedius, producing mild extrinsic narrowing. The vein drains at least the apical and posterior segments of the right upper lobe and possibly the anterior segment as well, explaining its large caliber. The SVC is relatively small, which is noted as consistent with the prominence of this pulmonary vein.
Key takeaways
Unusually large pulmonary veins are a rare anatomical variant that can produce extrinsic compression of adjacent bronchi when the vessel is sufficiently enlarged. When a large pulmonary vein is seen posterolateral to the bronchus intermedius and SVC is relatively small, the variant drainage pattern should be recognized as benign. These large caliber pulmonary veins can mimic mediastinal masses on chest radiograph and should be identified and characterized on CT to avoid unnecessary workup.
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