Postsurgical anatomy

Lung transplantation
Lobectomy and pneumonectomy
Lung transplantation
Lung Transplantation

Creation of pulmonary vein cuff during lung

Hassani C, Saremi F. transplantation
Comprehensive Cross-sectional Imaging of the Pulmonary
Lung Transplantation

In cases post arterial cuff reconstruction or donor with

single pulmonary vein
The left arterial cuff will appear much larger than native
Hassani C, Saremi F. Comprehensive Cross-sectional Imaging of the Pulmonary
Lung Transplantation

Indentation indicating left atrial cuff post

Hassani C, Saremi F. transplantation
Comprehensive Cross-sectional Imaging of the Pulmonary
Lung Transplantation

Caliber change indicating left atrial cuff post

Hassani C, Saremi F. transplantation
Comprehensive Cross-sectional Imaging of the Pulmonary
Lung Transplantation

Change in wall thickness and surgical clip indicating left

atrial cuff post transplantation
Hassani C, Saremi F. Comprehensive Cross-sectional Imaging of the Pulmonary
Lobectomy and pneumonectomy
Lobectomy and
pneumonectomy

The pulmonary vein stump is completely opacified with

contrast material
Surgical
Hassani C,clip isF.observed
Saremi Comprehensiveadjacent toImaging
Cross-sectional the stump
of the Pulmonary
Major anomalies
Partial anomalous pulmonary venous return
Total anomalous pulmonary venous return
Major anomalies
•Broadly categorized as PAPVR
and TAPVR
•Pulmonary veins drain into
systemic vein
•Left to right shunt
•Increased volume in the
pulmonary circulation
Hassani C, Saremi F. Comprehensive Cross-sectional Imaging of the Pulmonary
PAPVR
PAPVR

Left PAPVR
Vertical vein or Cardinal vein connecting superior pulmonary
Hassani C,vein
Saremito
F. left brachiocephalic
Comprehensive vein
Cross-sectional Imaging of the Pulmonary
PAPVR

Left PAPVR
LACV (levoatriocardinal vein) connecting left superior
pulmonary to left brachiocephalic vein
Left superior
Hassanipulmonary vein also Cross-sectional
C, Saremi F. Comprehensive has normalImaging
drainage into the
of the Pulmonary
PAPVR

Bidirectional flow creates a bridge between LA and left

brachiocephalic vein
With potential of paradoxical embolism if the flow is reversed
Hassani C, Saremi F. Comprehensive Cross-sectional Imaging of the Pulmonary
PAPVR

Right upper lobe PAPVR Sinus venosus ASD

With dilatation and
thickening of RV
Hassani C, Saremi F. Comprehensive Cross-sectional Imaging of the Pulmonary
PAPVR

Scimitar sign resembling Right lung hypoplasia

Turkish sword Scimitar vein drains into IVC
Systemic arterial supply

Hassani C, Saremi F. Comprehensive Cross-sectional Imaging of the Pulmonary

TAPVR
TAPVR

Supracardiac TAPVR with all pulmonary veins draining into a

single chamber ->
vertical vein -> SVC
Hassani C, Saremi F. Comprehensive Cross-sectional Imaging of the Pulmonary
TAPVR

Snowman sign in chest radiography in a patient with

supracardiac TAPVR
Hassani C, Saremi F. Comprehensive Cross-sectional Imaging of the Pulmonary
TAPVR

Snowman sign - Left border: vertical

vein
- Superior border: left
brachiocephalic vein
Hassani C, Saremi F. Comprehensive Cross-sectional
- Right border: dilated Imaging
SVC of the Pulmonary
Acquired conditions
Thrombosis
Stenosis
Pseudostenosis
Tumors and masses
Pulmonary vein thrombosis
Pulmonary vein
thrombosis

Hyperattenuating clot in the right common pulmonary vein

In axial nonenhanced CT image
Hassani C, Saremi F. Comprehensive Cross-sectional Imaging of the Pulmonary
Pulmonary vein
thrombosis

Well-defined rounded filling defect

Seen in the left inferior pulmonary vein stump with surgical clip
Hassani C, Saremi F. Comprehensive Cross-sectional Imaging of the Pulmonary
Pulmonary vein
thrombosis

Asymmetrical decreased enhancement of right pulmonary

arteries
* C,
Hassani Pulmonary hemorrhage
Saremi F. Comprehensive and edema
Cross-sectional Imaging of the Pulmonary
Pulmonary vein stenosis
Pulmonary vein
stenosis

Focal pulmonary vein stenosis with *mediastinal soft tissue

thickening
Hassani C, Saremi F. Comprehensive Cross-sectional Imaging of the Pulmonary
Pulmonary vein
stenosis

Focal pulmonary vein stenosis with

*focal pulmonary edema from impaired venous return
Hassani C, Saremi F. Comprehensive Cross-sectional Imaging of the Pulmonary
Pulmonary vein
stenosis

Decreased Focal stenosis – Post stent

enhancement improved from placement
Focal stenosis angioplasty
Native pulmonary *Worsen
vein pulmonary Cross-sectional
Hassani C, Saremi F. Comprehensive edema Imaging of the Pulmonary
Pulmonary vein
stenosis

In-stent thrombosis demonstrated as filling defect within the

stent
Hassani C, Saremi F. Comprehensive Cross-sectional Imaging of the Pulmonary
Pulmonary vein pseudostenosis
Pulmonary vein
pseudostenosis

Left inferior pulmonary vein with narrowing due to mass effect

from aorta
Hassani C, Saremi F. Comprehensive Cross-sectional Imaging of the Pulmonary
Tumor or masses
Tumor or masses

Nodular expansion into the pulmonary lumen which is

contiguous with the *lung cancer mass
Hassani C, Saremi F. Comprehensive Cross-sectional Imaging of the Pulmonary
Tumor or masses

*Esophageal cancer with heterogeneously enhancing tumor

thrombus in the left inferior pulmonary vein
Hassani C, Saremi F. Comprehensive Cross-sectional Imaging of the Pulmonary