J Korean Soc Radiol.  2010 Oct;63(4):345-349.

Asymptomatic Primary Isolated Pulmonary Vein Stenosis in an Adult: A Case Report

• Kim JH
• Lee HS
• Choi JS
• Na JO
• Kim YH
• Jou SS
• Seo KH

Abstract

A 31-year-old man without respiratory symptoms was transferred to our clinic with incidentally detected small nodular densities in both the upper lung zones on chest radiography. Chest computed tomography and pulmonary angiography demonstrated that the entrance of the right inferior pulmonary vein to the left atrium was completely blocked, and the venous return of the right lower lobe was achieved through the right superior pulmonary vein with a tortuous venous collateral complex in the venous phase. With echocardiography, mild pulmonary hypertension was detected. Here, we present an asymptomatic adult with isolated stenosis of the pulmonary vein with chronic compensation by venous collateral circulation in spite of mild pulmonary hypertension.

MeSH Terms

Adult
Angiography
Collateral Circulation
Compensation and Redress
Constriction, Pathologic
Echocardiography
Heart Atria
Humans
Hypertension, Pulmonary
Lung
Pulmonary Veins
Pulmonary Veno-Occlusive Disease
Thorax

Figure

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  Fig. 1 Echocardiogram shows only turbulent jet flows (arrow) originating from the pulmonary veins and entering the left atrium on apical four chamber view in figure 1A and mild pulmonary hypertension with 38.3 mmHg systolic pulmonary artery pressure (RA pressure 5 mmHg + maximal pressure gradient 33.3 mmHg) in figure 1B.

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  Fig. 2 Chest radiograph shows small nodular densities (arrows) with pleural thickening (arrow heads) in both upper lung zones and a dilated pulmonary vascular structure in the right hilar region (black arrow).

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  Fig. 3 Contrast-enhanced CT scan shows markedly a dilated right superior pulmonary vein (A) without connection to the left atrium (B), and multiple nodules suggesting collateral vascular structures in the pleural area of both upper lung zones (C) and in the superior segment of right lower lobe (D).

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  Fig. 4 Volume rendering image shows that the right inferior pulmonary vein drains to the superior pulmonary vein an through intrapulmonary venous connection (arrows).

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  Fig. 5 Selective angiogram of right lower lobar pulmonary artery shows that the entrance of the right inferior pulmonary vein to the left atrium was completely blocked (arrow), and the venous return of right lower lobe was achieved through the right superior pulmonary vein with tortuous venous collateral complex around the right hilar region in venous phase.

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