CTICasesRight Upper Lobe PAPVR with Superior Sinus Venosus ASD
Imaging findings
Chest radiograph shows a 'balanced distribution' of pulmonary blood flow (increased upper lobe vascularity mimicking congestion but without septal lines). CT angiography confirms a superior sinus venosus atrial septal defect (ASD) and partial anomalous pulmonary venous return (PAPVR) of the right upper lobe veins to the superior vena cava (SVC).
Key takeaways
Sinus venosus ASD is almost always associated with PAPVR. This creates a left-to-right shunt. Radiographic clues include symmetric dilatation of the upper zone pulmonary vessels ('balanced flow'). Transthoracic echocardiography is frequently false-negative for this defect, requiring CT or transesophageal echo for confirmation.
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