Some authors suggest that left-sided PAPVR is easier to recognize than right-sided PAPVR on CT images, because of the high proportion of left PAPVR draining into a dilated left innominate vein through a vertical vein located laterally to the aortic arch, a finding that is easily detectable .
On CT images PAPVR of the left upper lobe can be mistaken for a left persistent superior vein cave (SVC) because both conditions are characterized by the presence of a "vertically oriented" anomalous vein, located laterally to the aortic arch; the main difference between these abnormalities is that in left persistent SVC CT scans show two vessels anteriorly to the left main bronchus, while in the left-upper lobe PAPVR there are not any vessels in that location, or there is one with a small caliber .
Therefore, generally young patients with suspected PAPVR undergo MR.
However, gadolinium-enhanced MR angiography is more accurate in defining the number and the type of the drainage of involved veins in PAPVR, because these images have a large field of view, present an excellent spatial resolution, and permit three-dimensional reconstruction.
Patients with PAPVR are usually asymptomatic or may present with heart murmurs, fatigue, dyspnea, and arrhythmias.
Imaging detection of pulmonary veins' anatomic variant and particularly of PAPVR is important in patients that are candidates for lobectomy for a primary lung neoplasm; in case of PAPVR that involves a pulmonary lobe other than that affected by the cancer, a possible right-sided heart failure may occur, because of increased blood flow through this anomalous vein.
In asymptomatic patients without significant shunt and signs of right heart overload surgery is not necessary Patients with PAPVR presenting with right ventricle enlargement, tricuspid regurgitation, or clinical symptoms should undergo surgical repair to avoid the development of pulmonary hypertension; surgery consists in implanting the anomalous vein directly into the left auricular appendage or the left atrium [14,15].
Our patient's cardiological evaluation did not reveal any abnormalities, so she continued with periodic follow-up without any treatments related to PAPVR.