Noncyanotic, increased pulmonary blood flow
An 19 year-old male patient presented clinic because of an abnormal chest CT finding
![PAPVR](https://q-radiology.com/wp-content/uploads/2022/11/image-169-1024x779.png)
![PAPVR](https://q-radiology.com/wp-content/uploads/2022/11/image-170.png)
![PAPVR](https://q-radiology.com/wp-content/uploads/2022/11/image-171.png)
What is the partial anomalous pulmonary venous return (PAPVR)?
PAPVR is a congenital anomaly that involves drainage of one to three pulmonary veins into the systemic veins, creating a partial left to right shunt.
Characteristics of PAPVR
Incidence
– 0.5% in the general population.
Associated abnormality
– Most commonly ASD, approximately 25%
Symptom
– Asymptomatic, usually incidental radiographic finding
– Lt-to-Rt shunt, pulmonary hypertension, Rt-sided heart failure
Treatment
– Surgery
– Indication
a) LR shunt ratio exceeding 2:1
b) Coexistent congenital heart disease
![Distribution of PAPVR in adults](https://q-radiology.com/wp-content/uploads/2022/11/image-172.png)
Left upper lobe, most common (47%)
Right upper lobe (38%)
Right lower lobe (13%)
Left lower lobe (2%)
RUL PAPVR
– Drains into SVC
– Often associated with sinus venosus ASD
![](https://q-radiology.com/wp-content/uploads/2022/11/image-173-1024x463.png)
RLL PAPVR
– Drains into IVC
– Scimitar syndrome (Combination of pulmonary hypoplasia and partial anomalous pulmonary venous return)
– Scimitar syndrome specifically is exceedingly rare, with an incidence of just 2 per 100,000 births
![Scimitar syndrome](https://q-radiology.com/wp-content/uploads/2022/11/image-174-1024x452.png)
Small right hemithorax, Right lung hypoplasia
Curvilinear structure at the base of the right lung curving toward the right cardiophrenic angle, PAPVR to the IVC.
![PAPVR](https://q-radiology.com/wp-content/uploads/2022/11/image-175-1024x749.png)
B) Left upper lobe PAPVR draining into the left innominate vein
C) Right lower lobe PAPVR draining into the inferior vena cava (IVC)
D) Sinus venosus ASD in a patient with right upper lobe PAPVR
Reference)
Charles S. White, Linda B. Haramati, Joseph Jen-Sho Chen, and Jeffrey M. Levsky (2014), Cardiac Imaging, Oxford university press
Jud W. Gurney, Helen T. Winer-Muram, et al. Diagnostic imaging Chest, II-4 6~7
Charles S. White, Linda B. Haramati, et al. Cardiac imaging.
Ho ML, Bhalla S, Bierhals A, et al. MDCT of partial anomalous pulmonary venous return (PAPVR) in adults. J Thorac Imaging 2009; 24:89–95