case_images: PMC10762869_01
case_images: Chest X-ray findings: A smooth curving structure projecting across the right pulmonary hilum toward the base of the lung.
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case_images: PMC10762869_01_PUL2-14-e12332-g002.jpg
case_images: pul212332-fig-0001
case_images: Chest X-ray showed a smooth curving structure projecting across the right pulmonary hilum toward the lung base. (Figure 1).
case_images: Computed tomography angiography imaging: The image reveals an enlargement of the pulmonary artery and its branches. Notably, the right pulmonary veins are not visualized in their expected location (circled). LA, left atrium; LDPA, left descending pulmonary artery; LPV, left pulmonary vein; RIPA, right interlobar pulmonary artery.
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case_images: PMC10762869_01_PUL2-14-e12332-g004.jpg
case_images: pul212332-fig-0002
case_images: Subsequent computed tomography angiography of the pulmonary arteries showed enlargement of the pulmonary artery and its branches, and the right pulmonary veins were not visualized in their expected location (Figure 2).
case_images: (a) CTA imaging shows the right pulmonary vein is dilated, with abnormal reflux into the right atrium. (b-d) Clear visualization of abnormal reflux of the right pulmonary vein into the right atrium is evident in the 3D reconstructed images from CTA, multiplanar reformation reconstructed images from CTA, and vascular reconstruction images using Mimics Research 20.0 software. 3D, three-dimensional; CTA, computed tomography angiography; RA, right atrium; RPV, right pulmonary vein; RV, right ventricle; SVC, superior vena cava.
case_images: PUL2-14-e12332-g003.jpg
case_images: PMC10762869_01_PUL2-14-e12332-g003.jpg
case_images: pul212332-fig-0003
case_images: There are multiple ways to demonstrate dilation of the right pulmonary veins, and abnormal drainage into the right atrium (Figure 3).
case_images: (a) Parasternal long axis view shows an enlarged right ventricle (arrow). (b) Suprasternal view depicts dilation of the main pulmonary artery (arrow). (c) Apical four chamber view on right ventricular contrast echocardiography demonstrates retrograde flow from the right pulmonary vein into the right atrium via the superior vena cava (arrow), correlating with scimitar syndrome anatomy.
case_images: PUL2-14-e12332-g001.jpg
case_images: PMC10762869_01_PUL2-14-e12332-g001.jpg
case_images: pul212332-fig-0004
case_images: Cardiac ultrasound demonstrated an enlarged right ventricle (Figure 4a), prominent pulmonary artery dilation (Figure 4b), with tricuspid regurgitation jet velocity measured at 3.4 m/s, suggestive of PAH. Right ventricular contrast echocardiography demonstrated retrograde flow from the right pulmonary vein into the right atrium via the superior vena cava, consistent with the findings of scimitar syndrome (Figure 4c).