CTICasesTotal Anomalous Pulmonary Venous Return with Eisenmenger Syndrome
Imaging findings
Chest radiography shows massive cardiomegaly, marked enlargement of the central pulmonary arteries, and peripheral vascular pruning. Contrast-enhanced CT demonstrates severe dilation of the main and lobar pulmonary arteries with extensive wall calcification, along with anomalous drainage of all pulmonary veins directly into the right atrium, which communicates with the left atrium through a large secundum atrial septal defect.
Key takeaways
Total anomalous pulmonary venous return can occasionally remain undiagnosed into adulthood, leading to severe pulmonary arterial hypertension and Eisenmenger syndrome. The presence of extensive calcification within the walls of dilated central pulmonary arteries on CT is a strong indicator of long-standing shunt-induced pulmonary hypertension and pulmonary atherosclerosis rather than chronic thromboembolic pulmonary hypertension.
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