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Table of Contents
CASE REPORT
Year : 2018  |  Volume : 20  |  Issue : 1  |  Page : 43-45

Meandering pulmonary vein: Very rare incidental finding


1 Department of Radiology, Health Sciences University, Konya Training and Research Hospital, Konya, Turkey
2 Department of Thoracic Surgery, Health Sciences University, Konya Training and Research Hospital, Konya, Turkey
3 Emergency and First Aid Program, Vocational School of Health Services, KTO Karatay University, Konya, Turkey

Date of Web Publication4-May-2018

Correspondence Address:
Dr. Mustafa Çalık
Department of Thoracic Surgery, Health Sciences University, Konya Training and Research Hospital, Konya
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ejop.ejop_4_18

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  Abstract 


Meandering pulmonary vein (MPV) is a rarely seen pulmonary vascular anomaly and confused with the scimitar syndrome which is more commonly seen. In this paper, we presented a case of left MPV which mimes arteriovenous malformation. A 30-year-old man was referred to our clinic for pulmonary nodule detected in routine evaluation before employment examination. Diagnosis of MPV was made by Pulmonary CT angiography. It showed abnormal drainage of upper lob pulmonary vein to the inferior pulmonary vein and form abnormal common pulmonary vein which shouldn't be exist. Because of any symptoms no further examination was recommended. According to our best knowledge to date only 17 cases reported in the literature. MPV diagnosis has been significantly changed by the means of advances in CT technology. Non-invasive diagnosis is possible with modern multisectional CT that clearly shows the anatomy of veins and enables the detailed MPV examination. Hereby, unnecessary radiological examination or surgery can be prevented.f veins and enables the detailed MPV examination.

Keywords: Arteriovenous malformation, meandering pulmonary vein, scimitar


How to cite this article:
Aygun MS, Çalık M, Çalık SG. Meandering pulmonary vein: Very rare incidental finding. Eurasian J Pulmonol 2018;20:43-5

How to cite this URL:
Aygun MS, Çalık M, Çalık SG. Meandering pulmonary vein: Very rare incidental finding. Eurasian J Pulmonol [serial online] 2018 [cited 2019 Apr 26];20:43-5. Available from: http://www.eurasianjpulmonol.com/text.asp?2018/20/1/43/231810




  Introduction Top


Meandering pulmonary vein (MPV) is a rarely seen pulmonary vascular anomaly and confused with the scimitar syndrome or solitary pulmonary nodules. In both conditions, there is an abnormal pulmonary vein that courses in a way different from normal. These veins generally form a scimitar sign or a view mimicking arteriovenous (AV) malformation on the chest X-ray. MPV normally ends in the left atrium as opposed to scimitar splitting into inferior vena cava. The most significant point in differential diagnosis with AV malformation (AVM) is the absence of a feeding artery.[1],[2] In this paper, we presented a case of left MPV which mimics AV malformation.


  Case Report Top


A 30-year-old male was referred to our clinic because of pulmonary nodule detected in his routine X-ray evaluation performed for this job entrance examination. Posterior-anterior lung roentgenogram showed linear opacity on the left lung [Figure 1]. Pulmonary computed tomography (CT) showed dilated venous structure without any feeding vessel. The venous structure drained to normal localized inferior pulmonary vein. The patient underwent angiography for exclusion AVM, but no feeding vessel was detected [Figure 2]. Angiography confirmed normal inferior pulmonary veins and abnormal drainage of the left upper lobe pulmonary venous system. Diagnosis of MPV was made under existing findings. Colored three-dimensional volume rendering images of CT angiography was reconstructed using workstation, and it showed abnormal drainage of upper lobe pulmonary vein to the inferior pulmonary vein and form abnormal common pulmonary vein which should not be existed [Figure 3]. No additional monitoring was recommended for the patient as he did not have any complaint. Written informed consent was obtained from patient who is presented in this paper.
Figure 1: Scanogram before computed tomography revealed tubular-shaped vascular structure on the left lung

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Figure 2: Pulmonary angiography showed (a) normal arterial vessels but (b) abnormal vein that drain to inferior pulmonary vein

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Figure 3: Colored three-dimensional volume rendering of the pulmonary veins and heart illustrated abnormal drainage of the left superior pulmonary vein to inferior pulmonary vein. The abnormal course of upper pulmonary vein is showed with white arrow

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  Discussion Top


The term “meandering pulmonary vein” has firstly been used by Goodman et al. in the presence of scimitar sign to define the abnormal right pulmonary vein splitting into left atrium.[3] Scimitar sign describes a curved shadow on chest X-ray, which courses along the right cardiac border toward the right cardiophrenic angle. However, apart from the scimitar's syndrome, there is neither pulmonary hypoplasia nor shunt because drainage of the abnormal vein is orthotropic, means there is an abnormal coursed vein that drains to normal the left atrium, so there is no shunt.

On the contrary to scimitar syndrome and AVM that are commonly occur, the number of left MPV cases reported in literature is very low. According to the best of our knowledge, only 17 cases being right, left, and bilateral have been reported in literature up to now. However, only three cases on the left-sided MPV have been found in the literature so far.[4]

Predisposing factors or embryogenetic factors are not well described in MPV because of limited reports. MPV seems to be not related with hypogenetic lung, in contrast to scimitar. Furthermore, it is known that there are many pulmonary venous variations and it is possible that MPV is one of them, but rare type.

MPV diagnosis has been significantly changed by the means of advances in CT technology. In some cases, angiography can be optionally performed to differentiate it from scimitar syndrome and AVM which usually has to be treated.[5] Noninvasive diagnosis is possible with modern multisectional CT that clearly shows the anatomy of veins and enables the detailed MPV examination. Hereby, unnecessary radiological examination or surgery can be prevented.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Engelke C, Brown K, Sabharwal T, Reidy JF. Anomalous unilateral single pulmonary vein masquerading as a pulmonary arteriovenous malformation. AJR Am J Roentgenol 2001;176:1333.  Back to cited text no. 1
[PUBMED]    
2.
Gilkeson RC, Haaga JR, Ciancibello LM. Anomalous unilateral single pulmonary vein: Multidetector CT findings. AJR Am J Roentgenol 2000;175:1464-5.  Back to cited text no. 2
    
3.
Gwinn JL, Barnes GR Jr. The scimitar syndrome. Anomalies of great vessels associated with lung hypoplasia. Am J Dis Child 1967;114:585-6.  Back to cited text no. 3
[PUBMED]    
4.
Rodrigues MA, Ritchie G, Murchison JT. Incidental meandering right pulmonary vein, literature review and proposed nomenclature revision. World J Radiol 2013;5:215-9.  Back to cited text no. 4
[PUBMED]    
5.
Tsang TK, Kwan TL, Wong WK, Fung HS, Wai AMW. Anomalous unilateral single pulmonary vein – a rare mimicker of pulmonary arteriovenous malformation. J HK Coll Radiol 2007;10:16-8.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]


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[Pubmed] | [DOI]



 

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