CTICasesRuptured Type B Aortic Dissection and Bilateral Partial Anomalous Pulmonary Venous Return
Imaging findings
Chest radiography shows mediastinal widening, left pleural effusion, and multiple anomalous vascular coils. Contrast-enhanced CT angiogram demonstrates a ruptured Type B aortic dissection originating distal to the left subclavian artery, with extensive mediastinal hematoma (hemomediastinum) and right hemothorax. Concurrently, there is bilateral partial anomalous pulmonary venous return (PAPVR), with anomalous veins from the left upper lobe draining to a left-sided SVC and the right upper lobe draining to the right atrium, as well as a central venous catheter coming down the right internal jugular vein and abnormally coursing into the right anomalous pulmonary vein.
Key takeaways
Bilateral partial anomalous pulmonary venous return (PAPVR) is a rare congenital vascular anomaly that can be incidentally identified, sometimes following the malposition of a central venous catheter into the anomalous venous channel. In emergency scenarios, it is critical that these baseline congenital vascular abnormalities do not distract the radiologist from diagnosing acute, life-threatening pathologies, such as a ruptured Type B aortic dissection.
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