• Images in cardiology

A 12 year old boy was referred to our department for magnetic resonance imaging (MRI) of a known pulmonary arteriovenous malformation. The pulmonary malformation had been previously diagnosed by catheter angiography at the age of 1 year after a murmur had been noted over the left lung during a routine examination. So far the boy had always been asymptomatic and healthy. Regular follow up examinations, including two angiographies, showed a stable condition.

Frontal (A) and lateral (C) view of conventional angiography with the catheter in the pulmonary artery (PA). Corresponding (B and D) three dimensional volume renderings of a time resolved MRA during an early arterial phase. Similar to conventional catheter angiography, MRA depicts two aberrant dilated pulmonary veins (PV, arrowheads) draining from a posterior lung segment of the left lower lobe.

Imaging was performed on a 1.5 T whole body scanner (Magnetom Vision, Siemens, Erlangen, Germany). The imaging protocol included a time resolved, contrast enhanced magnetic resonance angiography (MRA) after injection of 0.2 mmol/kg bodyweight Gd-DTPA (Magnevist, Schering, Berlin, Germany). For this purpose an ultrafast three dimensional gradient echo pulse sequence (3D-FLASH, TR/TE = 2.3/0.9 ms, flip angle 40°, FOV 263 × 350 mm², matrix 135 × 265, slab thickness 78 mm, number of partitions 39, reconstructed slice thickness 2.0 mm) with a scan time of 6.2 s was performed. In total five data sets were acquired in a single breath hold showing the transit of the contrast agent bolus through the pulmonary vasculature.

Similar to conventional catheter angiography, MRI demonstrated two aberrant dilated pulmonary veins draining from a posterior lung segment of the left lower lobe (below left, panels A–D). In addition an aortopulmonary collateral to the anterior segment of the left lower lobe was clearly depicted. This lung segment showed venous congestion (below right).

Three dimensional volume rendering of a time resolved MRA (frontal view). MRA depicts an aortopulmonary collateral (APC) to the anterior segment of the left lower lobe and venous congestion. PV, pulmonary vein.