Thomaidis Michail, Mitsos Sofoklis, Leivaditis Vasileios, Kordimos Nikolaos, Papatriantafyllou Athanasios, Koletsis Efstratios N, Tomos Periklis
Department of Thoracic Surgery, Attikon General Hospital, National and Kapodistrian University of Athens, Athens, GRC.
Department of Cardiothoracic and Vascular Surgery, Westpfalz-Klinikum, Kaiserslautern, DEU.
Cureus. 2025 Aug 4;17(8):e89376. doi: 10.7759/cureus.89376. eCollection 2025 Aug.
Left-sided partial anomalous pulmonary venous return (PAPVR) may remain clinically silent and undiagnosed until incidentally identified, potentially introducing complexity in perioperative assessment and management, particularly in patients with significant comorbidities. We report the case of a 77-year-old male with metastatic colorectal adenocarcinoma and a history of multiple right-sided pulmonary metastasectomies. He underwent a right completion upper bilobectomy. Postoperatively, placement of a central venous line in the left internal jugular vein (selected due to intraoperative accessibility, although the right side is generally preferred for central access) revealed unexpectedly high oxygen saturation levels, prompting an urgent computed tomography angiogram. Imaging confirmed a previously undiagnosed left-sided PAPVR, with drainage of the left upper pulmonary vein into the left jugular vein. The central line was removed and replaced on the contralateral side. No surgical correction was required due to the asymptomatic nature and contralateral location of the anomaly. The patient recovered uneventfully, aside from a brief episode of atrial fibrillation managed conservatively. This case highlights the importance of maintaining clinical awareness of vascular anomalies such as PAPVR in thoracic surgical patients. Incidental findings may have significant implications for central venous access, anesthetic management, and postoperative care. Thorough imaging review and effective interdisciplinary communication are essential to ensure optimal outcomes.
左侧部分性肺静脉异位引流（PAPVR）在临床上可能一直没有症状且未被诊断出来，直到偶然被发现，这可能会给围手术期评估和管理带来复杂性，尤其是在患有严重合并症的患者中。我们报告了一例77岁男性患者，患有转移性结直肠癌，有多次右侧肺转移瘤切除术史。他接受了右侧全上叶切除术。术后，在左颈内静脉置入中心静脉导管（选择该侧是因为术中易于操作，尽管通常首选右侧进行中心静脉置管）时，意外发现氧饱和度水平很高，这促使紧急进行计算机断层血管造影。影像学检查证实了此前未被诊断出的左侧PAPVR，左上肺静脉引流至左颈静脉。中心静脉导管被拔除并在对侧重新置入。由于该异常情况无症状且位于对侧，因此无需进行手术矫正。除了通过保守治疗短暂控制了一次房颤发作外，患者恢复顺利。该病例强调了对胸部手术患者保持对诸如PAPVR等血管异常的临床警惕性的重要性。偶然发现可能对中心静脉置管、麻醉管理和术后护理有重大影响。全面的影像学检查评估和有效的多学科沟通对于确保最佳治疗效果至关重要。
