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A 61 year old man presented at our hospital with exertional dyspnoea. Transthoracic echocardiography showed dilatation of the right atrium and the right ventricle. Further assessment was performed using electrocardiographic gated, enhanced multislice computed tomography (CT) (Aquilion, Toshiba, Japan). The multiplanar reformations and the three dimensional reconstructed images with volume rendering clearly showed the atrial septal defect (ASD) at the upper border of the atrial septum (panels A and D), which was overridden by the superior vena cava orifice (panels C and D). In addition, the CT images revealed abnormal return of right upper pulmonary veins connected to the superior vena cava (panels B and D), and normal drainage of the other three pulmonary veins to the left atrium in the postero-anterior view of the volume rendered image (panel E). The patient was diagnosed with sinus venosus type of atrial septal defect with partial anomalous pulmonary venous return.
Partial anomalous pulmonary venous return is a congenital anomaly in which one or more, but not all, of the pulmonary veins are connected to a systemic vein or to the right atrium. It is often difficult to detect the pulmonary vein confluence or the combined congenital anomaly by echocardiography and catheter based angiography. Multislice CT is a promising non-invasive technique that may provide useful information on anatomical abnormalities. Moreover, it may obviate the need for angiography and be an important supplement to echocardiography.
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