CTICasesSinus Venosus Atrial Septal Defect and Partial Anomalous Pulmonary Venous Return with Eisenmenger Syndrome
Imaging findings
Chest CT shows a sinus venosus atrial septal defect with anomalous pulmonary venous drainage of the right upper lung into the superior vena cava. Despite a prior diagnosis of chronic thromboembolic disease, the scan reveals a large, calcified mural thrombus in a massively dilated main pulmonary artery, accompanied by right-to-left shunting of contrast from the right atrium directly into the left atrium, reflecting Eisenmenger physiology.
Key takeaways
Large mural thrombi in the setting of severe pulmonary hypertension and Eisenmenger syndrome can be misdiagnosed as chronic thromboembolic pulmonary hypertension. Identifying structural congenital shunts, such as a sinus venosus defect with partial anomalous pulmonary venous return, is vital because they alter flow hemodynamics, result in right-to-left shunting, and are often the root cause of the severe pulmonary hypertension.
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