ANOMALOUS PULMONARY VENOUS DRAINAGE OF RIGHT LUNG INTO INFERIOR VENA CAVA WITH MALROTATION OF THE HEART: REPORT OF THREE CASES

Abstract

Asymptomatic patients (3) with marked rotation of the heart into the right hemithorax had anomalous pulmonary venous drainage from the right lung into the inferior vena cava. In two, the characteristic appearance of the multiple-branching crescentic trunk adjacent to the right cardiac border in the conventional roentgenogram was a significant clue in diagnosis. In the other, the anomalous channels were obscured by the heart. Angiocardiography provided the definitive diagnosis in two cases and was useful in demonstrating the degree of cardiac and pulmonary arterial rotation. Of great importance was the demonstration of the anomalous right pulmonary arterial tree, the presence of a left-right shunt (recirculation of blood) and absence of an atrial septal defect. Anomalies of the right lung, pleura, diaphragm and bronchial tree may be a factor in cardiovascular rotation. In the absence of further proof, it is probable that the malrotation of the heart is an accompanying condition. Scrutiny of the right lower lung vasculature of patients with dextrocardia and dextroversion of the heart is recommended in order not to overlook vascular anomalies of the right lung.