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The Eye Does not See What the Mind Does not Know

The Eye Does not See What the Mind Does not Know
This is a 69 years old lady with pulmonary hypertension. Her lung window images from a CT pulmonary angiogram shows a mosaic perfusion pattern that would suggest chronic pulmonary thrombo-embolism. The accompanying CT PA did not show thrombi. The MPA was dilated suggesting pulmonary hypertension and she was labeled as idiopathic PH. The images came for an opinion.
A golden rule in patients with PH who get a contrast CT done is to trace the vessels. When we did that, we found a cause. The right superior pulmonary vein drains into the SVC anomalously with a sinus venosus ASD and resultant PH with RA and RV dilatation.She has lived 69 years with this. I wonder if any surgery at this stage is worth the effort. That will be an interesting conundrum.
#ctscan #ctpa #sinusvenosusasd #pulmonaryhypertension #mosaicpattern from Instagram: