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Crisscross pulmonary arteries with partial anomalous pulmonary venous drainage on multislice cardiac CT
J o u r n a l o f C a r d i o v a s c u l a r C o m p u t e d T o m o g r a p h y 9 ( 2 0 1 5 ) 7 1 e7 3
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.JournalofCardiovascularCT.com
Images in Cardiovascular CT
Crisscross pulmonary arteries with partial anomalous pulmonary venous drainage on multislice cardiac CT Madhan Kumar Murugan MDa, Priya Jagia MD, DNBa,*, Anita Saxena DMb a
Department of Cardiac Radiology, Cardiothoracic Sciences center, All India Institute of Medical Sciences, New Delhi 110029, India b Department of Cardiology, Cardiothoracic Sciences center, All India Institute of Medical Sciences, New Delhi, India
article info
abstract
Article history:
Criss cross pulmonary arteries is a rare entity characterized by classic malposition of
Received 27 June 2014
pulmonary arteries. It may be associated with other conotruncal malformations and
Accepted 3 July 2014
genetic syndromes. This report describes a case of crisscross pulmonary arteries associated
Available online 23 August 2014
with anomalous pulmonary venous return, an association which has never been reported before in literature.
Keywords:
ª 2015 Society of Cardiovascular Computed Tomography. All rights reserved.
Crissecross pulmonary arteries Anomalous pulmonary venous return Malposed pulmonary arteries
A 15-month-old boy with poor weight gain and recurrent respiratory infections underwent cardiac CT angiography using dual-source CT after echocardiography showed large ventricular septal defect and a suspicious anomalous pulmonary venous return. CT angiography revealed a large subaortic ventricular septal defect and dilated main pulmonary artery. The pulmonary arteries (PAs) were crossing each other to course toward their respective lung parenchyma, with the left PA arising superior and to the right of the right PA (Fig. 1). Bilateral superior venae cavae (SVC) were present with a small intercommunicating vein (Fig. 2). The left SVC also received drainage from the left upper lobe pulmonary vein and drained into the coronary sinus (Fig. 2).
The pattern of “crisscross pulmonary arteries” (CPA) is a rare classic malposition of the branch pulmonary arteries, which is considered benign but may be associated with other anomalies. Typically, the pulmonary arteries cross each other. Alternatively, the left PA ostium may lie directly superior to the right PA ostium.1 The anomaly is commonly attributed to differential growth of the pulmonary trunk causing counterclockwise rotation of the PA branches.2,3 Although conotruncal malformations, arch anomalies, left SVC and septal defects have been reported in association with CPA3e5 and about 45% of CPAs are associated with genetic syndromes,5 this, to our knowledge, is the first reported case of crisscross pulmonary arteries associated with anomalous pulmonary venous return.
Conflict of interest: The authors declare no conflict of interest. * Corresponding author. E-mail address: [email protected] (P. Jagia). 1934-5925/$ e see front matter ª 2015 Society of Cardiovascular Computed Tomography. All rights reserved. http://dx.doi.org/10.1016/j.jcct.2014.07.008
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J o u r n a l o f C a r d i o v a s c u l a r C o m p u t e d T o m o g r a p h y 9 ( 2 0 1 5 ) 7 1 e7 3
references
1. Cuturilo G, Drakulic D, Krstic A, et al. The role of modern imaging techniques in the diagnosis of malposition of the branch pulmonary arteries and possible association with microdeletion 22q11.2. Cardiol Young. 2013;23:181e188. 2. Zimmerman FJ, Berdusis K, Wright KL, Alboliras ET. Echocardiographic diagnosis of anomalous origins of the pulmonary arteries from the pulmonary trunk (crossed pulmonary arteries). Am Heart J. 1997;133:257e260.
3. Wolf WJ, Casta A, Nichols M. Anomalous origin and malposition of the pulmonary arteries (crisscross pulmonary arteries) associated with complex congenital heart disease. Pediatr Cardiol. 1986;6:287e291. 4. Becker AE, Becker MJ, Edwards JE. Malposition of pulmonary arteries (crossed pulmonary arteries) in persistent truncus arteriosus. Am J Roentgenol Radium Ther Nucl Med. 1970;110:509e514. lu K, Altun G, Binnetog lu K, et al. Crossed pulmonary 5. Babaog arteries: a report on 20 cases with an emphasis on the clinical features and the genetic and cardiac abnormalities. Pediatr Cardiol. 2013;34:1785e1790.
Fig. 1 e Cardiac CT angiography volume-rendered images (A, B), multiplanar reformat in sagittal oblique orientation (C), and axial image (D) showing the malposition of the pulmonary arteries wherein the left pulmonary artery (LPA) is superior and to the right of right pulmonary artery (RPA), and the 2 vessels cross each other. The main pulmonary artery (MPA) is dilated. The superior vena cava duplicated (red arrow, left superior vena cava (SVC); yellow arrow, right SVC). As A, ascending aorta, dta, descending thoracic aorta; RV, right ventricle. (For interpretation of the references to the color elements mentioned in the figure caption, the reader is directed to the Web version of the article.)
J o u r n a l o f C a r d i o v a s c u l a r C o m p u t e d T o m o g r a p h y 9 ( 2 0 1 5 ) 7 1 e7 3
73
Fig. 2 e Volume-rendered posterior image (A) and oblique maximum intensity projection reformats (B, C). The left superior vena cava (SVC) and right SVC are connected by a small intercommunicating vein (green arrowhead ). The left upper lobe pulmonary vein drains directly in to the left SVC, which drains into the coronary sinus. There is an aberrant origin of the right subclavian artery (white arrow) passing posteriorly to the right side from the left side. As A, ascending aorta; CS, coronary sinus; IVC, inferior vena cava; LA, left atrium; LPA, left pulmonary artery; LLPV, left lower pulmonary vein; LUPV, left upper pulmonary vein; RA, right atrium; RLPV, right lower pulmonary vein; RMPV, right middle pulmonary vein; RPA, right pulmonary artery; RUPV, right upper pulmonary vein. Yellow colored arrow denotes right SVC while red one denotes left SVC. (For interpretation of the references to the color elements mentioned in the figure caption, the reader is directed to the Web version of the article.)
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.JournalofCardiovascularCT.com
Images in Cardiovascular CT
Crisscross pulmonary arteries with partial anomalous pulmonary venous drainage on multislice cardiac CT Madhan Kumar Murugan MDa, Priya Jagia MD, DNBa,*, Anita Saxena DMb a
Department of Cardiac Radiology, Cardiothoracic Sciences center, All India Institute of Medical Sciences, New Delhi 110029, India b Department of Cardiology, Cardiothoracic Sciences center, All India Institute of Medical Sciences, New Delhi, India
article info
abstract
Article history:
Criss cross pulmonary arteries is a rare entity characterized by classic malposition of
Received 27 June 2014
pulmonary arteries. It may be associated with other conotruncal malformations and
Accepted 3 July 2014
genetic syndromes. This report describes a case of crisscross pulmonary arteries associated
Available online 23 August 2014
with anomalous pulmonary venous return, an association which has never been reported before in literature.
Keywords:
ª 2015 Society of Cardiovascular Computed Tomography. All rights reserved.
Crissecross pulmonary arteries Anomalous pulmonary venous return Malposed pulmonary arteries
A 15-month-old boy with poor weight gain and recurrent respiratory infections underwent cardiac CT angiography using dual-source CT after echocardiography showed large ventricular septal defect and a suspicious anomalous pulmonary venous return. CT angiography revealed a large subaortic ventricular septal defect and dilated main pulmonary artery. The pulmonary arteries (PAs) were crossing each other to course toward their respective lung parenchyma, with the left PA arising superior and to the right of the right PA (Fig. 1). Bilateral superior venae cavae (SVC) were present with a small intercommunicating vein (Fig. 2). The left SVC also received drainage from the left upper lobe pulmonary vein and drained into the coronary sinus (Fig. 2).
The pattern of “crisscross pulmonary arteries” (CPA) is a rare classic malposition of the branch pulmonary arteries, which is considered benign but may be associated with other anomalies. Typically, the pulmonary arteries cross each other. Alternatively, the left PA ostium may lie directly superior to the right PA ostium.1 The anomaly is commonly attributed to differential growth of the pulmonary trunk causing counterclockwise rotation of the PA branches.2,3 Although conotruncal malformations, arch anomalies, left SVC and septal defects have been reported in association with CPA3e5 and about 45% of CPAs are associated with genetic syndromes,5 this, to our knowledge, is the first reported case of crisscross pulmonary arteries associated with anomalous pulmonary venous return.
Conflict of interest: The authors declare no conflict of interest. * Corresponding author. E-mail address: [email protected] (P. Jagia). 1934-5925/$ e see front matter ª 2015 Society of Cardiovascular Computed Tomography. All rights reserved. http://dx.doi.org/10.1016/j.jcct.2014.07.008
72
J o u r n a l o f C a r d i o v a s c u l a r C o m p u t e d T o m o g r a p h y 9 ( 2 0 1 5 ) 7 1 e7 3
references
1. Cuturilo G, Drakulic D, Krstic A, et al. The role of modern imaging techniques in the diagnosis of malposition of the branch pulmonary arteries and possible association with microdeletion 22q11.2. Cardiol Young. 2013;23:181e188. 2. Zimmerman FJ, Berdusis K, Wright KL, Alboliras ET. Echocardiographic diagnosis of anomalous origins of the pulmonary arteries from the pulmonary trunk (crossed pulmonary arteries). Am Heart J. 1997;133:257e260.
3. Wolf WJ, Casta A, Nichols M. Anomalous origin and malposition of the pulmonary arteries (crisscross pulmonary arteries) associated with complex congenital heart disease. Pediatr Cardiol. 1986;6:287e291. 4. Becker AE, Becker MJ, Edwards JE. Malposition of pulmonary arteries (crossed pulmonary arteries) in persistent truncus arteriosus. Am J Roentgenol Radium Ther Nucl Med. 1970;110:509e514. lu K, Altun G, Binnetog lu K, et al. Crossed pulmonary 5. Babaog arteries: a report on 20 cases with an emphasis on the clinical features and the genetic and cardiac abnormalities. Pediatr Cardiol. 2013;34:1785e1790.
Fig. 1 e Cardiac CT angiography volume-rendered images (A, B), multiplanar reformat in sagittal oblique orientation (C), and axial image (D) showing the malposition of the pulmonary arteries wherein the left pulmonary artery (LPA) is superior and to the right of right pulmonary artery (RPA), and the 2 vessels cross each other. The main pulmonary artery (MPA) is dilated. The superior vena cava duplicated (red arrow, left superior vena cava (SVC); yellow arrow, right SVC). As A, ascending aorta, dta, descending thoracic aorta; RV, right ventricle. (For interpretation of the references to the color elements mentioned in the figure caption, the reader is directed to the Web version of the article.)
J o u r n a l o f C a r d i o v a s c u l a r C o m p u t e d T o m o g r a p h y 9 ( 2 0 1 5 ) 7 1 e7 3
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Fig. 2 e Volume-rendered posterior image (A) and oblique maximum intensity projection reformats (B, C). The left superior vena cava (SVC) and right SVC are connected by a small intercommunicating vein (green arrowhead ). The left upper lobe pulmonary vein drains directly in to the left SVC, which drains into the coronary sinus. There is an aberrant origin of the right subclavian artery (white arrow) passing posteriorly to the right side from the left side. As A, ascending aorta; CS, coronary sinus; IVC, inferior vena cava; LA, left atrium; LPA, left pulmonary artery; LLPV, left lower pulmonary vein; LUPV, left upper pulmonary vein; RA, right atrium; RLPV, right lower pulmonary vein; RMPV, right middle pulmonary vein; RPA, right pulmonary artery; RUPV, right upper pulmonary vein. Yellow colored arrow denotes right SVC while red one denotes left SVC. (For interpretation of the references to the color elements mentioned in the figure caption, the reader is directed to the Web version of the article.)