Metastases to the heart

The pulmonary veins carry oxygenated blood from the lungs to the heart, but their importance to the radiologist extends far beyond this seemingly straightforward function. The anatomy of the pulmonary veins is variable among patients, with several noteworthy variant and anomalous patterns, including supernumerary pulmonary veins, a common ostium, anomalous pulmonary venous return, and levoatriocardinal veins. Differences in pulmonary vein anatomy and the presence of variant or anomalous anatomy can be of critical importance, especially for preoperative planning of pulmonary and cardiac surgery. The enhancement or lack of enhancement of the pulmonary veins can be a clue to clinically important disease, and the relationship of masses to the pulmonary veins can herald cardiac invasion. The pulmonary veins are also an integral part of thoracic interventions, including lung transplantation, pneumonectomy, and radiofrequency ablation for atrial fibrillation. This fact creates a requirement for radiologists to have knowledge of the pre- and postoperative imaging appearances of the pulmonary veins. Many of these procedures are associated with important potential complications involving the pulmonary veins, for which diagnostic imaging plays a critical role. A thorough knowledge of the pulmonary veins and a proper radiologic approach to their evaluation is critical for the busy radiologist who must incorporate the pulmonary veins into a routine "search pattern" at computed tomography (CT) and magnetic resonance imaging. This article is a comprehensive CT-based imaging review of the pulmonary veins, including their embryology, anatomy (typical and anomalous), surgical implications, pulmonary vein thrombosis, pulmonary vein stenosis, pulmonary vein pseudostenosis, and the relationship of tumors to the pulmonary veins. Online supplemental material is available for this article. ©RSNA, 2017.

Comprehensive Cross-sectional Imaging of the Pulmonary Veins.

Pulmonary vein thrombosis in patients with medical risk factors.

Pulmonary vein thrombosis (PVT) is a rarely encountered disease entity with varied clinical presentations. It has been reported to be associated with underlying lung malignancy in multiple case reports. Diagnosis can be challenging due to nonspecific symptoms on presentation. Herein, we report a 67-year-old male patient with a history of extensive smoking and chronic obstructive pulmonary disease (COPD) who presented with multiple hemoptysis episodes. CT scan of the chest with contrast showed multiple right lower lobe (RLL) lung masses and a thrombus in the inferior pulmonary vein. After various imaging modalities and transthoracic biopsy of the lung mass, the patient was diagnosed with pulmonary vein tumor thrombus secondary to poorly differentiated bronchogenic carcinoma with intracardiac extension. The patient was started on Eliquis for anticoagulation and is currently in the process of beginning chemo/radiation therapy for the underlying malignancy.

Peng Zha

Papers

An Atypically Large, Free-Floating Thrombus Extending From the Lung to the Left Atrium via a Pulmonary Vein: A Case Report.