Published online May 28, 2013. doi: 10.4329/wjr.v5.i5.215
Revised: March 29, 2013
Accepted: May 8, 2013
Published online: May 28, 2013
Processing time: 128 Days and 5.8 Hours
We report a case of an anomalous pulmonary vein on chest X-ray resembling a scimitar sign in an 80-year-old female undergoing investigation of syncope. Multislice computed tomography (CT) with multiplanar reformatting and maximum intensity projections demonstrated an aberrant right inferior pulmonary vein coursing inferomedially towards the diaphragm before turning superiorly and draining normally into the left atrium. The diagnosis of an incidental meandering right pulmonary vein was established. The case is used to review the literature on this rare pulmonary anomaly, including pathogenesis, its relationship with scimitar syndrome and scimitar variant, and diagnosis, with an emphasis on the role modern CT techniques can play in non-invasive diagnosis. A revision to the nomenclature of pulmonary vascular anomalies is proposed to help reduce confusion in the literature.
Core tip: This case highlights the chest X-ray features of scimitar syndrome are not diagnostic and a meandering right pulmonary vein (MRPV) should be considered in the differential diagnosis. The nomenclature used in the literature to describe these pulmonary vascular anomalies is inconsistent. We therefore propose a revision to the nomenclature to avoid confusion. Differentiation between pulmonary vascular anomalies is required to help decide whether treatment is necessary. Modern multislice computed tomography technology allows clear depiction of the vascular connections and associated anatomy, and has superseded invasive pulmonary angiography and cardiac catheterization as the investigation of choice for MRPV.