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Case of the Month – August 2018

By Dr Jatin Patel

Patient history:

Patient noticed lump, anterior neck, two months prior to doctor visit.

Imaging and Findings:

X-ray chest – incidental finding of nodular opacity adjacent to left heart border. Query nodules.

CT thorax – There is an anomalous left sided single pulmonary vein, with upper lobe moiety combining with the left inferior pulmonary moiety, with a single point of drainage into the left atrium. This is also referred to as meandering pulmonary vein. There is varix dilatation of the left upper lobe vein adjacent to the left heart border accounting for the findings on the recent x-ray. No arterial feeder seen adjacent to the varix. A CT pulmonary angiogram (CTPA) examination is suggested to exclude potential arterial feeder, hence an arteriovenous malformation, as this would require different management.

CTPA – Although the pulmonary arteries and veins are similarly opacified on this CTPA study, there is no convincing secondary evidence of a pulmonary artery/vein arteriovenous malformation.

Findings consistent with a variant single left pulmonary vein with associated anomalous, meandering left upper lobe pulmonary vein and varicose dilatation in the lingual segment.

Management:

Non urgent cardiologist referral with a view to echocardiography, to exclude any feature of intrapulmonary shunt may be warranted.

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