Total anomalous pulmonary venous connection in an adult

This chest radiograph (fig 1, left panel) and reconstructed cardiac computed tomography angiography scan (fig 1, right panel) show a rare example of unobstructed supracardiac total anomalous pulmonary venous connection (TAPVC).1 The patient, a woman in her 30s, presented with worsening dyspnoea, cyanosis, and digital clubbing of the fingers and toes.bmj;385/apr25_7/e076278/F1F1f1Fig 1In this congenital malformation a common chamber is formed by all four pulmonary veins (fig 1, right panel) coursing into the superior vena cava through a vertical vein and the left brachiocephalic vein (BCV). Left atrial inflow is through an obligatory right to left shunting atrial septal defect. The radiograph (fig 1, left panel) shows an enlarged cardiac silhouette in a classic “figure of 8” or “snowman” appearance, as a result of the enlarged superior vena cava and vertical vein giving rise to an additional spherical configuration above an enlarged cardiac silhouette. Dilated pulmonary arteries and multiple end-on vessels…
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