Gadolinium-enhanced three-dimensional magnetic resonance angiography of pulmonary and systemic venous anomalies
Gerald F. Greil, MD*,
Andrew J. Powell, MD, FACC* ,
Hans P. Gildein, MD* and
Tal Geva, MD, FACC*  ,*
* Department of Cardiology, Children’s Hospital, Boston, Massachusetts, USA
Department of Radiology, Children’s Hospital, Boston, Massachusetts, USA
Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA
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Figure 1 Gadolinium-enhanced three-dimensional magnetic resonance angiography in a 12-year-old patient with scimitar syndrome. Subvolume maximal intensity projection image in the coronal plane demonstrates the right pulmonary veins (RPV) draining into the suprahepatic segment of the inferior vena cava (IVC). AoD = descending aorta; RA = right atrium.
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Figure 2 Gadolinium-enhanced three-dimensional magnetic resonance angiography in a newborn with mixed totally anomalous pulmonary venous connection. Subvolume maximal intensity projection image in the coronal plane demonstrates the left upper pulmonary vein (LUPV), left lower pulmonary vein (LLPV) and right lower pulmonary veins (RLPV) draining to a horizontal vertical vein (VV), which connects through a severely narrow communication to the portal vein (not shown). A cranial extension of the vertical vein (*) traverses through the right lung with a tortuous course that ends with a stenotic connection to the superior vena cava (SVC). The right upper pulmonary vein (RUPV) drains into the cranial aspect of the tortuous vessel. AoD = descending aorta.
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Figure 3 Gadolinium-enhanced three-dimensional magnetic resonance angiography (MRA) in a three-month-old infant with bilateral pulmonary veins stenosis. (A) Subvolume maximal intensity projection (MIP) image in the coronal plane shows severe stenosis of the common left pulmonary vein (LPV) (white arrow). The wall of the common right pulmonary vein (RPV) is irregular and moderately stenotic (black arrow). (B) Subvolume MIP image in the axial plane demonstrates the severe stenosis of the common LPV and the moderately narrow and irregular common RPV. The MRA findings were confirmed at autopsy. AoD = descending aorta; LA = left atrium; LLPV = left lower pulmonary vein; LMPV = left middle pulmonary vein; LUPV = left upper pulmonary vein; RA = right atrium; RV = right ventricle.
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Figure 4 Gadolinium-enhanced three-dimensional magnetic resonance angiography in a patient with a functional single ventricle, status post bidirectional Glenn shunt. (A) Subvolume maximal intensity project (MIP) image in an oblique coronal plane shows the left lower pulmonary vein (LLPV) with an adequate superior-inferior caliber. (B) Subvolume MIP image in the axial plane demonstrates that the LLPV is compressed between the descending aorta (AoD) and the left atrium (LA). RA = right atrium.
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Figure 5 Inferior vena cava (IVC) obstruction in a patient who underwent Baffes procedure (24) for transposition of the great arteries. (A) Subvolume maximal intensity project (MIP) image in the coronal plane demonstrates severe stenosis of the IVC (arrow). Note the dilated azygos vein. (B) Subvolume MIP image in the sagittal plane shows the anteroposterior relationship of the IVC with the right atrium. The magnetic resonance angiography findings were confirmed at cardiac catheterization and a stent was placed across the stenotic segment of the IVC.
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